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Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?
Author(s) -
Rozen Warren M.,
Anavekar Namrata S.,
Ashton Mark W.,
Stella Damien L.,
Grinsell Damien,
Bloom Richard J.,
Taylor G. Ian
Publication year - 2008
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20526
Subject(s) - medicine , breast reconstruction , computed tomography angiography , surgery , radiology , microsurgery , angiography , vascularity , dissection (medical) , diep flap , breast cancer , cancer
Background: Breast reconstruction is increasingly performed with the use of the abdominal wall donor site, with potential complications including donor site morbidity and impaired flap viability. As a tool for selecting the optimal perforators which will ultimately supply the flap, preoperative imaging with computed tomography angiography (CTA) has become increasingly popular. Potential benefits include reduced intramuscular dissection, with faster and safer dissection, reduced donor site morbidity and improved flap vascularity and survival. Despite the potential for improvements in operative outcome, any benefits are yet to be established. Methods: A cohort study of 104 breast reconstructions in 88 patients was conducted. All patients underwent breast reconstruction based on an abdominal wall free flap. Of these, 40 patients undergoing preoperative imaging with CTA and 48 patients not undergoing CTA were included, with all CTAs undertaken at a single institution. Length of operation, length of stay, and operative complications were assessed. An evaluation of operative stress was achieved with the use of visual analogue scales (VAS) administered to the surgeons. Results: The use of CTA was associated with decreased operating time (mean: 77 min for bilateral cases), significantly decreased complications related to flap viability (particularly partial flap loss), and a statistically significant reduction in donor site morbidity. Psychometric testing of surgeons revealed a statistically significant decrease in operative stress (41% decrease) with the use of preoperative CTA. Conclusion: The use of CTA for preoperative imaging in breast reconstruction is associated with improved operative outcomes. © 2008 Wiley‐Liss, Inc. Microsurgery, 2008.