5.11 The role of CTA in assessing DIEP flap perforator patency in patients with pre-existing abdominal scars.

L. M. Ngaage1, R. Hamed3, B. Di Pace2,5, G. Oni2, B. Koo4, C. M. Malata2,6,7  1University Of Cambridge,Clinical School Of Medicine,Cambridge, ENGLAND, United Kingdom 2Addenbrooke’s Hospital,Plastic & Reconstructive Surgery,Cambridge, ENGLAND, United Kingdom 3The University Of Alexandria Medical School,Alexandria, ALEXANDRIA, Egypt 4Addenbrooke’s Hospital,Radiology,Cambridge, ENGLAND, United Kingdom 5Università Degli Studi Della Campania Luigi Vanvitelli,Plastic Surgery Unit,Naples, NAPLES, Italy 6Addenbrooke’s Hospital,Cambridge Breast Unit,Cambridge, ENGLAND, United Kingdom 7Anglia Ruskin University,Postgraduate Medical Institute, Faculty Of Medical Sciences,Cambridge & Chelmsford, ENGLAND, United Kingdom

Introduction: Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning abdominal free flap breast reconstruction (FFBR). Computed tomographic angiography (CTA) is routinely used for preoperative DIEA flap imaging. Few studies address the effects of scars on DIEA perforator patency. We, therefore, investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens.

 

Methods: A single surgeon’s first 100 CTA FFBR patients were studied. All were imaged by one radiologist (BK). CTA reports, abdominal scars and flap intraoperative details were analysed. The operative findings were then correlated with the CTA "predictions".

 

Results: 100 patients with preoperative CTAs underwent 141 FFBRs 39% (55) from scarred and 61% (86) from virgin abdomens. All flap transfers were successful. Overall, concordance between the best perforator chosen by CTA pre-operatively and that selected by the surgeon intraoperatively was 95.6% (scarred 92.7%; non-scarred 97.5%,?p=0.18). There was no difference in the proportion of single-perforator flaps in the two groups (scarred 39%; non-scarred 37%). “Scarred” flaps were heavier (775 vs 675g, p=0.04) and their reconstructions took an hour longer (563 vs 502 minutes, p=0.03). Two patients had abnormal incidental CTA findings that precluded flap harvest (DIEA occlusion from previous surgery and a large mesenteric aneurysm).

 

Conclusion: CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. Scarring increases the duration of FFBR. Discovery of incidental CTA abnormalities can prevent doomed-to-fail or unsafe free flap surgery. Our study confirms the utility of CTA in facilitating FFBR from scarred abdomens.?