J Reconstr Microsurg 2017; 33(05): 328-335
DOI: 10.1055/s-0037-1598617
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

Malik Mossa-Basha
1   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
,
Clara Lee
2   Department of Plastic Surgery, The Ohio State University, Columbus, Ohio
› Author Affiliations
Further Information

Publication History

10 August 2016

26 December 2016

Publication Date:
24 February 2017 (online)

Abstract

Introduction CT angiogram (CTA) is widely believed to improve operative time and flap outcomes for perforator flap breast reconstruction, but the quality of the evidence is not known. We conducted a systematic review of the efficacy of preoperative CTA for abdominal perforator flap breast reconstruction.

Methods Inclusion criteria included published articles in English, CTA group, and control group, between 2000 and March 2013. Medline and PubMed were queried. Study quality criteria were developed based on standards of internal and external validity. One reviewer screened titles and abstracts. Two authors independently reviewed the full-text articles. Outcomes of interest were operative time and flap outcomes.

Results Ten publications met inclusion criteria. Study designs included retrospective or mixed prospective-retrospective cohorts. In every study, the control group time period preceded the CTA group time period and no studies adjusted for improved surgical skill (i.e., learning curve effect). Sample sizes ranged from 41 to 357. Five studies did not perform or provide statistical analysis for the results presented. The mean quality rating was 2.8 (out of a maximum of 7). Seven of 10 studies found a shorter operative time with CTA. Two of nine studies found fewer partial flap failures with CTA.

Conclusion CTA is associated with shorter operative time, but some of this may be due to a learning curve effect. The evidence does not show a difference in flap outcomes. The evidence in support of preoperative CTA is limited and subject to bias due to study design.

Supplementary Material

 
  • References

  • 1 Gacto-Sánchez P, Sicilia-Castro D, Gómez-Cía T. , et al. Computed tomographic angiography with VirSSPA three-dimensional software for perforator navigation improves perioperative outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg 2010; 125 (01) 24-31
  • 2 Casey III WJ, Chew RT, Rebecca AM, Smith AA, Collins JM, Pockaj BA. Advantages of preoperative computed tomography in deep inferior epigastric artery perforator flap breast reconstruction. Plast Reconstr Surg 2009; 123 (04) 1148-1155
  • 3 Ghattaura A, Henton J, Jallali N. , et al. One hundred cases of abdominal-based free flaps in breast reconstruction. The impact of preoperative computed tomographic angiography. J Plast Reconstr Aesthet Surg 2010; 63 (10) 1597-1601
  • 4 Malhotra A, Chhaya N, Nsiah-Sarbeng P, Mosahebi A. CT-guided deep inferior epigastric perforator (DIEP) flap localization—better for the patient, the surgeon, and the hospital. Clin Radiol 2013; 68 (02) 131-138
  • 5 Masia J, Kosutic D, Clavero JA, Larranaga J, Vives L, Pons G. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg 2010; 26 (01) 21-28
  • 6 Minqiang X, Lanhua M, Jie L, Dali M, Jinguo L. The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps. Br J Radiol 2010; 83 (985) 40-43
  • 7 Rozen WM, Anavekar NS, Ashton MW. , et al. Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?. Microsurgery 2008; 28 (07) 516-523
  • 8 Smit JM, Dimopoulou A, Liss AG. , et al. Preoperative CT angiography reduces surgery time in perforator flap reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (09) 1112-1117
  • 9 Tong WM, Dixon R, Ekis H, Halvorson EG. The impact of preoperative CT angiography on breast reconstruction with abdominal perforator flaps. Ann Plast Surg 2012; 68 (05) 525-530
  • 10 Uppal RS, Casaer B, Van Landuyt K, Blondeel P. The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (07) 859-864
  • 11 Birkmeyer JDST, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349 (22) 2117-2127
  • 12 Finks JFON, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 2011; 364 (22) 2128-2137
  • 13 Harmon JWTD, Tang DG, Gordon TA. , et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 1999; 230 (03) 404-411 , discussion 411–413
  • 14 Cina A, Salgarello M, Barone-Adesi L, Rinaldi P, Bonomo L. Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler US. Radiology 2010; 255 (03) 979-987
  • 15 Casey III WJ, Rebecca AM, Kreymerman PA, Macias LH. Computed tomographic angiography: assessing outcomes. Clin Plast Surg 2011; 38 (02) 241-252
  • 16 Rozen WM, Chubb D, Grinsell D, Ashton MW. Computed tomographic angiography: clinical applications. Clin Plast Surg 2011; 38 (02) 229-239
  • 17 Schaverien MV, Ludman CN, Neil-Dwyer J, McCulley SJ. Contrast-enhanced magnetic resonance angiography for preoperative imaging of deep inferior epigastric artery perforator flaps: advantages and disadvantages compared with computed tomography angiography: a United Kingdom perspective. Ann Plast Surg 2011; 67 (06) 671-674
  • 18 Higgins JPT, Green S. , eds Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011
  • 19 Karunanithy N, Rose V, Lim AK, Mitchell A. CT angiography of inferior epigastric and gluteal perforating arteries before free flap breast reconstruction. Radiographics 2011; 31 (05) 1307-1319
  • 20 Nahabedian MY, Patel KM. Maximizing the use of the handheld Doppler in autologous breast reconstruction. Clin Plast Surg 2011; 38 (02) 213-218
  • 21 Lam DL, Mitsumori LM, Neligan PC, Warren BH, Shuman WP, Dubinsky TJ. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery. Br J Radiol 2012; 85 (1020): e1293-e1297
  • 22 Rozen WM, Ashton MW. Modifying techniques in deep inferior epigastric artery perforator flap harvest with the use of preoperative imaging. ANZ J Surg 2009; 79 (09) 598-603
  • 23 Keys KA, Louie O, Said HK, Neligan PC, Mathes DW. Clinical utility of CT angiography in DIEP breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (03) e61-e65
  • 24 Molina AR, Jones ME, Hazari A, Francis I, Nduka C. Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients. Ann R Coll Surg Engl 2012; 94 (07) 493-495
  • 25 Rozen WM, Stella DL, Bowden J, Taylor GI, Ashton MW. Advances in the pre-operative planning of deep inferior epigastric artery perforator flaps: magnetic resonance angiography. Microsurgery 2009; 29 (02) 119-123
  • 26 Masia J, Clavero JA, Larrañaga JR, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg 2006; 59 (06) 594-599
  • 27 Masia J, Larrañaga J, Clavero JA, Vives L, Pons G, Pons JM. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap: our experience in 162 cases. Ann Plast Surg 2008; 60 (01) 29-36
  • 28 Schaverien MV, Ludman CN, Neil-Dwyer J. , et al. Contrast-enhanced magnetic resonance angiography for preoperative imaging in DIEP flap breast reconstruction. Plast Reconstr Surg 2011; 128 (01) 56-62
  • 29 Klasson S, Svensson H, Malm K, Wassélius J, Velander P. Preoperative CT angiography versus Doppler ultrasound mapping of abdominal perforator in DIEP breast reconstructions: a randomized prospective study. J Plast Reconstr Aesthet Surg 2015; 68 (06) 782-786