The effect of CT angiography and venous couplers on surgery duration in microvascular breast reconstruction: a single operator’s experience

Ngaage, Ledibabari M. and Oni, Georgette and Di Pace, Bruno and Hamed, Raed R. and Fopp, Laura J. and Koo, Brendan C. and Malata, Charles M. (2018) The effect of CT angiography and venous couplers on surgery duration in microvascular breast reconstruction: a single operator’s experience. Gland Surgery, 7 (5). pp. 440-448. ISSN 2227-684X

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Official URL: https://doi.org/10.21037/gs.2018.07.11

Abstract

Background: The use of CT angiography (CTA) or venous couplers (VCs) 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 VC only, 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: One hundred and twenty 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 vs. WI (472 vs. 586 min, P<0.00001) and vs. VC alone (472 vs. 572 min, P=0.0006). Similarly, introduction of each intervention showed a stepwise decrease in ischaemia time (WI vs. VC: 100 vs. 89 min, P=0.0106; VC vs. CT-VC: 89 vs. 80 min, P=0.0307; WI vs. CT-VC: 100 vs. 80 min, P<0.00001). Conclusions: Combination of CTA and VC 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.

Item Type: Journal Article
Keywords: Computed tomography angiography (CTA), deep inferior epigastric perforator flap (DIEP flap), microvascular breast reconstruction, operative time, venous coupler (VC)
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Lisa Blanshard
Date Deposited: 26 May 2020 13:54
Last Modified: 27 May 2020 13:16
URI: http://arro.anglia.ac.uk/id/eprint/705566

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