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Abdominally Based Free Flap Planning in Breast Reconstruction with Computed Tomographic Angiography: Systematic Review and Meta-Analysis

Ohkuma, Rika M.D.; Mohan, Raja M.D.; Baltodano, Pablo A. M.D.; Lacayo, Marcelo J. M.D.; Broyles, Justin M. M.D.; Schneider, Eric B. Ph.D.; Yamazaki, Michiyo M.H.S., Ph.D.; Cooney, Damon S. M.D., Ph.D.; Manahan, Michele A. M.D.; Rosson, Gedge D. M.D.

Plastic and Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 483–494
doi: 10.1097/01.prs.0000438058.44505.d8
Breast: Original Articles

Background: Computed tomographic angiography is often used for preoperative mapping. The authors aimed to systematically assess breast reconstruction outcomes after abdominally based free flaps planned with preoperative computed tomographic angiography versus Doppler ultrasonography.

Methods: A search of the PubMed, EMBASE, and Scopus databases and an additional hand-search of relevant articles until June of 2012 rendered 442 English-language citations. Three authors independently reviewed these citations and included all the studies comparing preoperative computed tomographic angiography versus Doppler ultrasonography with regard to short-term postoperative outcomes and operative times. A meta-analysis was performed to evaluate the incidence of flap-related complications (seven studies), donor-site morbidity (four studies), and operative times (five studies) between preoperative computed tomographic angiography and Doppler ultrasonography. A pooled relative risk was calculated using a random-effect model to compare complication rates between the computed tomographic angiography and Doppler ultrasonography groups.

Results: A total of 13 studies met inclusion criteria. Preoperative computed tomographic angiography was associated with significantly fewer flap-related complications (relative risk, 0.87; 95 percent CI, 0.78 to 0.97), reduced donor-site morbidity (relative risk, 0.84; 95 percent CI, 0.76 to 0.94), and shorter reconstruction operative time by 87.7 minutes (mean difference, 87.7 minutes; 95 percent CI, 78.3 to 97.1 minutes).

Conclusions: The use of preoperative computed tomographic angiography reduces the operative time, postoperative flap-related complications, and donor-site morbidity compared with Doppler ultrasonography. Preoperative computed tomographic angiography has the potential to reduce operative cost and increase efficiency in the operating room. Thus, preoperative mapping by computed tomographic angiography should be strongly considered for abdominally based free flap breast reconstruction.

Baltimore, Md.

From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.

Received for publication June 22, 2013; accepted September 5, 2013.

Poster presentation at 91st Annual Meeting of American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012; and podium presentation at the 57th Annual Meeting of the Plastic Surgery Research Council, in Ann Arbor, Michigan, June 14 through 17, 2012.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

Gedge D. Rosson, M.D., Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins Outpatient Center, 8th Floor, McElderry 8161, 601 North Caroline Street, Baltimore, Md. 21287,

©2014American Society of Plastic Surgeons