The DIEA Branching Pattern and Its Relationship to Perforators: The Importance of Preoperative Computed Tomographic Angiography for DIEA Perforator Flaps

2008 ◽  
Vol 121 (2) ◽  
pp. 367-373 ◽  
Author(s):  
Warren M. Rozen ◽  
Kate P. Palmer ◽  
Hiroo Suami ◽  
Wei R. Pan ◽  
Mark W. Ashton ◽  
...  
Keyword(s):  
Computed Tomographic Angiography ◽  
Branching Pattern ◽  
Perforator Flaps ◽  
Computed Tomographic ◽  
Tomographic Angiography

Efficiency Assessment of Multidetector-Row Computed Tomographic Angiography Using Reconstruction With Locoregional Perforator Flaps

2021 ◽  
pp. 229255032110247
Author(s):  
Pavlo O. Badiul ◽  
Sergii V. Sliesarenko ◽  
Nataliia O. Cherednychenko ◽  
Olga V. Morgun
Keyword(s):  
Perforator Flap ◽  
Computed Tomographic Angiography ◽  
Surgical Reconstruction ◽  
Patient Treatment ◽  
Controlled Study ◽  
Control Group ◽  
Perforator Flaps ◽  
Multidetector Row ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

Anatomical variations of aortic arch branching: evaluation with computed tomographic angiography

2013 ◽  
Vol 24 (3) ◽  
pp. 485-493 ◽  
Author(s):  
Alper Karacan ◽  
Aysel Türkvatan ◽  
Keziban Karacan
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Computed Tomographic Angiography ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Branching Pattern ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Type 3

AbstractPurpose: The aim of this study was to investigate the frequency and gender distribution of variations in the aortic arch branching pattern using 64-slice computed tomograhic angiography. Materials and methods: A total of 1000 patients with a normal left-sided aortic arch who underwent computed tomographic angiography for various reasons were analysed retrospectively for the frequency of variation of aortic arch branching; the variations were categorised into seven types. Results: Of the 1000 patients, 79.2% had a normal aortic arch branching pattern – type 1 – and 20.8% had variations. The frequency of type 2 variation – brachiocephalic and left common carotid arteries arising from the aortic arch in a common trunk – was 14.1%, that of type 3 – left vertebral artery originating from the aortic arch – was 4.1%, that of type 4 – coexistence of type 2 and type 3 – was 1.2%, that of type 5 – aberrant right subclavian artery – was 0.6%, that of type 6 – coexistence of aberrant right subclavian artery and bicarotid trunk – was 0.7%, and that for type 7 – thyroidea ima artery arising from the aortic arch – was 0.1%. The incidences of the variations of aortic arch branching were similar among males and females (20% versus 22.1%). The incidence of an aberrant right subclavian artery – type 5 and type 6 – was higher among females compared with males (2.5% versus 0.5), whereas the frequencies of the other variations were either equal or similar in both genders. Conclusion: Recognition of variations of aortic arch branching is important because they may cause symptoms due to tracheoesophageal compression or complications during surgical or endovascular interventional procedures of the aorta and its branches.

Preoperative Imaging for DIEA Perforator Flaps: A Comparative Study of Computed Tomographic Angiography and Doppler Ultrasound

2008 ◽  
Vol 121 (MOC-PS CME Coll) ◽  
pp. 1-8 ◽  
Author(s):  
Warren M. Rozen ◽  
Timothy J. Phillips ◽  
Mark W. Ashton ◽  
Damien L. Stella ◽  
Robert N. Gibson ◽  
...  
Keyword(s):  
Comparative Study ◽  
Doppler Ultrasound ◽  
Computed Tomographic Angiography ◽  
Preoperative Imaging ◽  
Perforator Flaps ◽  
Computed Tomographic ◽  
Tomographic Angiography

Peritoneo-cutaneous perforators in deep inferior epigastric perforator flaps: A cadaveric dissection and computed tomographic angiography study

Microsurgery ◽  
2008 ◽  
Vol 29 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Iain S. Whitaker ◽  
Warren M. Rozen ◽  
Jeroen M. Smit ◽  
Angeliki Dimopoulou ◽  
Mark W. Ashton ◽  
...  
Keyword(s):  
Computed Tomographic Angiography ◽  
Perforator Flaps ◽  
Cadaveric Dissection ◽  
Computed Tomographic ◽  
Deep Inferior Epigastric Perforator ◽  
Tomographic Angiography

Application of Three-Dimensional Printed Vascular Modeling as a Perioperative Guide to Perforator Mapping and Pedicle Dissection during Abdominal Flap Harvest for Breast Reconstruction

2020 ◽  
Vol 36 (05) ◽  
pp. 325-338 ◽  
Author(s):  
Michael V. DeFazio ◽  
Elsa M. Arribas ◽  
Faisal I. Ahmad ◽  
Huong T. Le-Petross ◽  
Jun Liu ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Three Dimensional ◽  
Computed Tomographic Angiography ◽  
Patient Specific ◽  
Branching Pattern ◽  
Computed Tomographic ◽  
Deep Inferior Epigastric Artery ◽  
3D Printed ◽  
Operative Findings ◽  
Tomographic Angiography

Abstract Background Advancements in three-dimensional (3D) printing have enabled production of patient-specific guides to aid perforator mapping and pedicle dissection during abdominal flap harvest. We present our early experience using this tool to navigate deep inferior epigastric artery (DIEA) topography and evaluate its impact on operative efficiency and clinical outcomes. Patients and Methods Between January 2013 and December 2018, a total of 50 women underwent computed tomographic angiography (CTA)-guided perforator mapping prior to abdominal flap breast reconstruction, with (n = 9) and without (n = 41) 3D-printed vascular modeling (3DVM). Models were assessed for their accuracy in identifying perforator location and source-vessel anatomy, as determined by operative findings from 18 hemi-abdomens. The margin of error (MOE) for perforator localization using 3DVM was calculated and compared with CTA-derived measurements for the same patients. Flap harvest times, outcomes, and complications for patients who were preoperatively mapped using 3DVM versus CTA alone were analyzed. Results Overall, complete concordance was observed between 3DVM and operative findings with regards to perforator number, source-vessel origin, and DIEA branching pattern. By comparison, CTA interpretation of these parameters inaccurately identified branching pattern and perforator source-vessel origin in 28 and 33% of hemi-abdomens, respectively (p = 0.045 and p = 0.02). Compared with operative measurements, the average MOE for perforator localization using 3DVM was significantly lower than that obtained from CTA alone (0.81 vs. 8.71 mm, p < 0.0001). Reference of 3D-printed models, intraoperatively, was associated with a mean reduction in flap harvest time by 21 minutes (60.7 vs. 81.7 minutes, p < 0.001). Although not statistically significant, rates of perforator-level injury, microvascular insufficiency, and fat necrosis were lower among patients mapped using 3DVM. Conclusion The results of this study support the accuracy of 3DVM for identifying DIEA topography and perforator location. Application of this technology may translate to enhanced operative efficiency and fewer perfusion-related complications for patients undergoing abdominal free flap breast reconstruction.

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