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Advantages of Preoperative Computed Tomography in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Casey, William J. III M.D.; Chew, Roderick T. M.D.; Rebecca, Alanna M. M.D.; Smith, Anthony A. M.D.; Collins, Joseph M. M.D.; Pockaj, Barbara A. M.D.

Plastic and Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - p 1148-1155
doi: 10.1097/PRS.0b013e31819e23e1
Breast: Original Articles

Background: Preoperative computed tomography has been used to facilitate deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction. This study identifies the improvements in outcome that this may provide.

Methods: A retrospective review of a consecutive series of DIEAP and superficial inferior epigastric artery (SIEA) flap breast reconstructions was performed over 5 years. All patients underwent hand-held Doppler interrogation of the abdomen. Patient demographics, operative times, and postoperative outcomes were compared before and after the routine use of computed tomographic imaging.

Results: Two hundred eighty-seven flaps were performed on 213 patients. There were 139 unilateral and 74 bilateral reconstructions, with 168 flaps performed immediately after mastectomy and 119 flaps performed in a delayed setting. One hundred one flaps were performed with computed tomographic imaging, whereas 186 flaps followed hand-held Doppler interrogation alone. Mean follow-up was 24 months. The use of computed tomography had a beneficial impact on operative times (unilateral, 370 versus 459 minutes; bilateral, 515 versus 657 minutes; p < 0.05), number of perforators included (1.5 versus 1.9; p < 0.05), and abdominal bulges (1 percent versus 9.1 percent; p < 0.05). Anastomotic complications (6.9 percent versus 8.1 percent), failure rates (2 percent versus 3.8 percent), fat necrosis (10.9 percent versus 13.4 percent), and abdominal wounds (11.8 percent versus 16.6 percent) were not found to be significantly different. Computed tomography did identify three cases of deep inferior epigastric vessel ligation from previous operations, which compromised these as suitable source vessels.

Conclusions: This study suggests that preoperative computed tomography leads to decreased operative times and a reduction in abdominal bulge rates, and may reduce the learning curve in DIEAP breast reconstruction compared with hand-held Doppler evaluation alone.

Phoenix, Ariz.

From the Division of Plastic and Reconstructive Surgery, the Department of Radiology, and the Department of General Surgery, Mayo Clinic Arizona.

Received for publication May 19, 2008; accepted October 27, 2008.

Disclosure: None of the authors has any financial interests or commercial relationships to disclose regarding the preparation, presentation, or submission of this article.

William J. Casey, III, M.D., Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Ariz. 85054,

©2009American Society of Plastic Surgeons