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CT-Angiography Prior to DIEP Flap Breast Reconstruction: A Randomized Controlled Trial - Interim Update

Freedman, Jonathan David Md, PhD; Colakoglu, Salih MD; Tebockhorst, Seth MD; Aycock, Joyce MD; Chong, Tae MD; Mathes, David W. MD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 4
doi: 10.1097/01.GOX.0000579812.64196.88
Mountain West 2019 Abstract Supplement

University of Colorado, Aurora, CO

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Microsurgical reconstruction of the breast with the Deep Inferior Epigastric Perforator (DIEP) flap offers less postoperative pain, lower abdominal morbidity, and better preservation of the rectus muscles than more conventional flaps. However, the variability of the vascular anatomy of the deep inferior epigastric artery and its perforating branches through the rectus muscle present a technical challenge that may result in long operative times. The location, number, and caliber of the perforators and the intramuscular trajectory of the arterial branches can be widely different in patients, including comparing the contralateral side in the same patient. Flap harvest therefore takes longer due to these technical considerations, and postoperative complications increase if a non-ideal perforator is selected intraoperatively as the basis for the flap. Prior knowledge of perforator anatomy can therefore, in theory, both decrease operative time and increase selection of the most reliable perforator.

This study is a randomized controlled study that investigates if pre-operative CT angiography will lower the dissection time required to perform bilateral deep inferior epigastric artery perforator flap breast reconstruction. We will present the interim data on 21 randomized patients. Patients were randomized to pre-operative CT angiography or forgo pre-operative imaging. Inclusion criteria mandated that all patients were candidates for and desired to undergo bilateral breast reconstruction with DIEP flaps. Endpoints include flap dissection time and complication rate.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.