CT-guided deep inferior epigastric perforator (DIEP) flap localization — Better for the patient, the surgeon, and the hospital

• Published in: Clinical radiology Vol. 68; no. 2; pp. 131 - 138
• Main Authors: Malhotra, A, Chhaya, N, Nsiah-Sarbeng, P, Mosahebi, A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2013
• Subjects: Adult; Aged; Angiography - methods; Blood Loss, Surgical; Breast Neoplasms - surgery; Case-Control Studies; Epigastric Arteries; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Length of Stay; Mammaplasty - methods; Mastectomy - methods; Middle Aged; Perforator Flap - blood supply; Preoperative Care - methods; Radiology; Rectus Abdominis - blood supply; Rectus Abdominis - transplantation; Retrospective Studies; Risk Assessment; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasonography, Mammary - methods; United Kingdom
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2012.06.105

Aims To define the clinical benefits to the patient of preoperative imaging planning for deep inferior epigastric perforator (DIEP) flap reconstruction. Materials and methods Since 2009 computed tomography angiography (CTA) has been provided for the preoperative planning of DIEP flap breast reconstruction in the largest plastic surgery unit in southeast England. In a retrospective, cohort–control study the outcomes of 100 consecutive patients who underwent preoperative CTA planning were compared with a closely-matched control group who underwent ultrasound planning only. The cohorts were evaluated for operative duration, mean operative blood loss and transfusion requirement, morbidity and flap or donor-site complications. Results There were statistically significant improvements in mean operative duration ( p <  0.05), intra-operative blood loss ( p <  0.05), shorter mean inpatient stay ( p <  0.05) for the CTA planning versus the ultrasound planning of DIEP flap reconstruction. Conclusion Statistically significant benefits were demonstrated in key aspects of the surgical procedure following CTA-guided planning. The implications of these benefits are profound in terms of pure healthcare cost benefits.