Plastic and Reconstructive Surgery: October 2020
- Volume 146 - Issue 4 - p 719-723
Background: In deep inferior epigastric perforator (DIEP)
flap breast reconstruction, many surgeons use preoperative imaging for
perforator mapping as a method to plan the operation, reduce operative times,
and potentially limit morbidity. This study compared operative times for
specific portions of DIEP flap harvest with and without preoperative computed
tomographic angiography imaging.
Methods: Two patient groups undergoing DIEP flap breast
reconstruction were studied prospectively. In the experimental group, the
harvesting surgeon was blinded to the preoperative computed tomographic
angiography scan; in the control group, the harvesting surgeon assessed the
scan preoperatively. Times for initial perforator identification, perforator
selection, flap harvest time, and total procedure times were compared.
Perforator choice was evaluated. Correlation of perforator choice
preoperatively and intraoperatively was also performed.
Results: Times were recorded in 60 DIEP flaps (27 blinded
and 33 unblinded). The nonblinded group was more efficient in all categories:
time to first perforator identification (28.6 minutes versus 17.8 minutes; p
< 0.0001), time to perforator decision-making (23.1 minutes versus 5.6
minutes; p < 0.0001), time to flap harvest (128 minutes versus 80 minutes; p
< 0.0001), and total operative time (417 minutes versus 353 minutes; p <
0.001). Perforator location was not different between groups. Blinded
intraoperative decisions correlated with preoperative imaging in 74 percent of
flaps. More perforators were included in the blinded flaps compared to the
nonblinded flaps (2.3 versus 1.4; p < 0.001).
Conclusions: Use of preoperative computed tomographic
angiography leads to decreased operative times, specifically with regard to
perforator identification and perforator selection. Without preoperative
computed tomographic angiography, surgeons included more perforators in the
flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
