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DOI: 10.1055/a-2110-0350
Preoperative Imaging Mapping of DIEP Perforators and Intraoperative Selection: Does It Correlate?
Funding Drs. Gravina, Singh, Conlon, and Spiegel have nothing to disclose. No funding was received for this article.
Abstract
Background Preoperative imaging prior to deep inferior epigastric perforator (DIEP) flap harvest is a common practice to locate perforators and identify aberrant anatomy.
Methods We report a retrospective review of 320 consecutive patients who underwent preoperative computed tomographic angiography (CTA) or magnetic resonance angiography prior to DIEP flap breast reconstruction. The locations relative to the umbilicus of preoperatively identified perforators were compared with the selected intraoperative perforators. The diameter of all intraoperative perforators was also measured.
Results Across the 320 patient, 1,833 potentially suitable perforators were identified on preoperative imaging. A total of 564 of the 795 perforators selected intraoperatively for DIEP flap harvest were within 2 cm of a predicted perforator, for a rate of 70.1%. The size of the perforator was unrelated to the detection rate.
Conclusion We were able to demonstrate a sensitivity of 70% of clinically selected DIEP perforators identified on preoperative imaging in this large series. This contrasts with the nearly 100% predictive value reported by others. Continued reporting of findings and methods of measuring are needed to improve the practical efficacy of CTA and raise awareness about the limitations of CTA, despite its well-documented usefulness.
Presented at (if applicable)
World Society of Reconstructive Microsurgery (WSRM) 2019 in Bologna, Italy; Texas Society of Plastic Surgery (TSPS) 2019 in Galveston, Texas.
Publication History
Received: 24 February 2023
Accepted: 08 June 2023
Accepted Manuscript online:
14 June 2023
Article published online:
10 August 2023
© 2023. Thieme. All rights reserved.
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