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J Reconstr Microsurg 2020; 36(05): 325-338
DOI: 10.1055/s-0039-1700991
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Application of Three-Dimensional Printed Vascular Modeling as a Perioperative Guide to Perforator Mapping and Pedicle Dissection during Abdominal Flap Harvest for Breast Reconstruction

Michael V. DeFazio
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Elsa M. Arribas 
2   Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Faisal I. Ahmad
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Huong T. Le-Petross
2   Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Jun Liu
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Carrie K. Chu
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Lumarie Santiago   ∗
2   Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Mark W. Clemens   ∗
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Further Information

Publication History

25 July 2019

02 December 2019

Publication Date:
30 January 2020 (online)

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Abstract

Background Advancements in three-dimensional (3D) printing have enabled production of patient-specific guides to aid perforator mapping and pedicle dissection during abdominal flap harvest. We present our early experience using this tool to navigate deep inferior epigastric artery (DIEA) topography and evaluate its impact on operative efficiency and clinical outcomes.

Patients and Methods Between January 2013 and December 2018, a total of 50 women underwent computed tomographic angiography (CTA)-guided perforator mapping prior to abdominal flap breast reconstruction, with (n = 9) and without (n = 41) 3D-printed vascular modeling (3DVM). Models were assessed for their accuracy in identifying perforator location and source-vessel anatomy, as determined by operative findings from 18 hemi-abdomens. The margin of error (MOE) for perforator localization using 3DVM was calculated and compared with CTA-derived measurements for the same patients. Flap harvest times, outcomes, and complications for patients who were preoperatively mapped using 3DVM versus CTA alone were analyzed.

Results Overall, complete concordance was observed between 3DVM and operative findings with regards to perforator number, source-vessel origin, and DIEA branching pattern. By comparison, CTA interpretation of these parameters inaccurately identified branching pattern and perforator source-vessel origin in 28 and 33% of hemi-abdomens, respectively (p = 0.045 and p = 0.02). Compared with operative measurements, the average MOE for perforator localization using 3DVM was significantly lower than that obtained from CTA alone (0.81 vs. 8.71 mm, p < 0.0001). Reference of 3D-printed models, intraoperatively, was associated with a mean reduction in flap harvest time by 21 minutes (60.7 vs. 81.7 minutes, p < 0.001). Although not statistically significant, rates of perforator-level injury, microvascular insufficiency, and fat necrosis were lower among patients mapped using 3DVM.

Conclusion The results of this study support the accuracy of 3DVM for identifying DIEA topography and perforator location. Application of this technology may translate to enhanced operative efficiency and fewer perfusion-related complications for patients undergoing abdominal free flap breast reconstruction.

Keywords

three-dimensional printing - breast reconstruction - computed tomographic angiography - deep inferior epigastric artery perforator flap - perforator mapping

∗ These authors are co-last authors.


 

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