The role of CT Angiography in assessing DIEP flap patency in patients with pre-existing abdominal scars

Ngaage, Ledibabari M. and Hamed, Raed and Di Pace, Bruno and Oni, Georgette and Koo, Brendan and Malata, Charles M. (2018) The role of CT Angiography in assessing DIEP flap patency in patients with pre-existing abdominal scars. In: 13th Annual Academic Surgical Congress, Jacksonville, Florida, USA.

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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 tomographic 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 analysed. The operative findings were then correlated with the CTA "predictions". Results: 106 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 676g, p=0.0244) than those harvested from virgin abdomens. Conclusion: CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. Discovery of incidental CTA abnormalities can prevent doomed-to-fail or unsafe flap surgery. “Scarred” flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intra-flap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs.

Item Type: Conference or Workshop Item (Paper)
Keywords: computed tomography angiography (CTA), free flap breast reconstruction, abdominal scars, operative time, DIEP flaps
Faculty: ARCHIVED Faculty of Medical Science (until September 2018)
Depositing User: Lisa Blanshard
Date Deposited: 28 Aug 2018 13:34
Last Modified: 09 Sep 2021 18:57

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