The Role of CT Angiography in Assessing Deep Inferior Epigastric Perforator Flap Patency in Patients With Pre-existing Abdominal Scars.
BACKGROUND
Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning free flap breast reconstruction (FFBR). Computed tomography angiography (CTA) is routinely used for preoperative DIEA flap imaging. We investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens.


METHODS
A single surgeon's CTA FFBR patients were studied. All were imaged by one radiologist. CTA reports, abdominal scars, and flap intraoperative details were analyzed. The operative findings were then correlated with the CTA "predictions."


RESULTS
A hundred and six patients with preoperative CTAs underwent 132 FFBRs, 44% (58) from scarred and 56% (74) from virgin abdomens. All flap transfers were successful. Concordance between perforators identified by CTA preoperatively and those selected by the surgeon intraoperatively was 95% (scarred 93%; non-scarred 96%, P = 0.470). There was a significant difference in the proportion of single-perforator flaps between the two groups (scarred 46%; non-scarred 28%, P = 0.041). "Scarred" flaps were heavier (789 vs 676 g, P = 0.0244) than those harvested from virgin abdomens.


CONCLUSIONS
CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. "Scarred" flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intraflap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs.
['Ngaage|Ledibabari M|LM|', 'Hamed|Raed|R|', 'Oni|Georgette|G|', 'Di Pace|Bruno|B|', 'Ghorra|Dina T|DT|', 'Koo BMedSci|Brendan C|BC|', 'Malata|Charles M|CM|']
D000328:Adult D000368:Aged D002921:Cicatrix D000072226:Computed Tomography Angiography D019074:Epigastric Arteries D005260:Female D006801:Humans D016462:Mammaplasty D008875:Middle Aged D061525:Perforator Flap D012189:Retrospective Studies
Free flap breast reconstruction Abdominal scars or scarred abdomen CT angiography or computed tomography angiography (CTA) DIEP flaps Operative time or surgery duration