Namita Sharma Gandhi MD, Presenter: Nothing to Disclose

Risal Djohan MD, Abstract Co-Author: Nothing to Disclose

Stacey Winners, Abstract Co-Author: Nothing to Disclose

Brian Robert Herts MD, Abstract Co-Author: Researcher, Siemens AG

Deep inferior epigastric perforator (DIEP) free flap is a newer technique for harvesting well-vascularized adipocutaneous tissue from the abdomen for breast reconstruction; advantages include minimal morbidity and preservation of rectus abdominis function. The surgery requires meticulous dissection and localization of dominant inferior epigastric artery perforators is essential for successful reconstruction. The purpose of this study was to evaluate the role of CT Angiography (CTA) in planning DIEP reconstruction.

21 patients underwent 26 DIEP breast reconstructions (16 unilateral, 5 bilateral) at our institution from August 2007 to March 2008. An abdominal wall CTA, 1-3 weeks prior to the surgery was performed in all patients, utilizing non-ionic contrast injected at a rate of 4 cc/sec and bolus tracking. Images (0.6mm collimation, 1 mm slice thickness, 0.75 mm interval) were reviewed using volume rendering software. The number and position of inferior epigastric artery perforators was noted with respect to the umbilicus and measured in millimeters . Based on results of the CTA, an intraoperative Doppler of the dominant perforator was obtained in all patients. The findings were correlated with intraoperative dissection and surgical results. Incidental CT findings were recorded.

The distance between expected localization based on CTA and surgical localization of the perforators ranged from 1-8 mm. Medial perforators were used in 18 cases, lateral perforators were used in 11 cases, both medial and lateral in 3 cases. There were no cases of flap failure. Two incidental findings (hepatic lesion, adrenal nodule) were both benign on further work up.

The anatomic localization of inferior epigastric artery perforators based on volume-rendered CT correlates well with findings on surgical dissection. Preoperative CTA of the inferior epigastric artery is an accurate tool for surgical planning of DIEP flaps.

Preoperative CTA can aid in appropriate surgical planning and hence reduce the time and morbidity associated with DIEP flap resonstruction surgery.

Gandhi, N, Djohan, R, Winners, S, Herts, B, Volume-rendered CTA of the Inferior Epigastric Artery Perforators: A Novel Technique for Presurgical Planning of DIEP Flap Breast Reconstructions.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6009866.html