The effect of CTA and venous couplers on surgery duration in microvascular breast reconstruction

Background: The use of CT angiography (CTA) or venous couplers (VC) has led to shorter operative times in free flap breast reconstruction (FFBR). However, there are no reports on the effect of these two interventions relative to each other or combined. Methods: Abdominal based FFBRs performed by a single surgeon before introduction of either intervention were compared to those with venous couplers only (VC), and those after the addition of CTA to VCs (CT-VC). Operative time was defined as from “knife-to-skin” to insertion of the last stitch. Results: 120 patients; 40 without intervention (WI), 40 with VC, and 40 with CT-VC. Introduction of VCs did not significantly reduce operative time compared to WI (p=0.73). However, patients in the CT-VC group had significantly shorter operations versus WI (472vs586 mins, p<0.00001) and versus VC alone (472vs572 mins, p=0.0006). Similarly, introduction of each intervention showed a stepwise decrease in ischaemia time (WI vs VC: 100vs89 mins, p=0.0106; VC vs CT-VC: 89vs80 mins, p=0.0307; 100vs80 mins, p<0.00001). Conclusions: Combination of CTA and venous couplers significantly reduced operative and ischaemic times for FFBR; this was predominantly due to use of CTA. CTA mitigates the surgical learning curve as demonstrated by shorter operating times via providing a vascular anatomy roadmap, thus facilitating flap harvest.