Daniel Rodriguez Bejarano MD, Presenter: Nothing to Disclose

Jose Antonio Narvaez MD, Abstract Co-Author: Nothing to Disclose

Javier Hernandez Ganan, Abstract Co-Author: Nothing to Disclose

Anna Lopez Ojeda, Abstract Co-Author: Nothing to Disclose

Tiago Gomes Rodrigues, Abstract Co-Author: Nothing to Disclose

Profunda Artery Perforator (PAP) flap is a new therapeutic alternative in autologous breast reconstruction. Is an excellent option in patients with surgical contraindications to abdominal tissue transfer (previous abdominoplasty), thinness or patient´s wish. Our purpose is to describe the imaging features of these branches and their correlation to suitable perforants intraoperatively.

Since the introduction of this new surgical technique in our hospital, a preoperative CTA was done in all cases. The CTA evaluation of the perforating arteries was performed with use of specific postprocessing and display techniques. A retrospective review of CTA and surgical findings of 20 patients, in which a PAP flap was performed between October 2012-March 2014, was done. Clinical data, CTA findings (number, size, location, relation with surrounding muscles, intramuscular and subcutaneous course of perforating arteries) and surgical reports were reviewed in all cases.  

Patient age ranged from 27 to 71 yr. In 3 cases a bilateral surgery was performed, being the initial procedure in all cases (no previous breast reconstructions). In all cases profunda artery perforators were identified. The average number of perforants was 1.2/patient, with an average diameter of 1.57mm. Most of the perforants were located near adductor magnus (73% of cases), coming out from adductor magnus muscule or from the fascial plane between gracilis/adductor magnus muscles, with an average distance from midline of 4.1cm. The average distance between gluteal fold and point of fascial exit was 3.5cm. Preoperative imaging findings correlated with suitable perforators intraoperatively in all cases. 

PAP flap is a good alternative in autologous breast reconstruction, mainly in patients with abdominal tissue not available, either for surgical causes (previous abdominal surgeries) or nonsurgical causes (thin patients, patient´s wish). CT angiography plays a key role identifying perforators preoperatively, having an excellent correlation with intraoperative findings, giving an adequate guide to surgeons to make an adequate flap choice and incision design. Therefore, avoids a potential negative surgical exploration.

CT Angiography in PAP flap provides information that helps the surgeon to optimize surgical planning, giving a guide to localize these branches, avoiding complications and negative explorations.  

Rodriguez Bejarano, D, Narvaez, J, Hernandez Ganan, J, Lopez Ojeda, A, Gomes Rodrigues, T, CT Angiography of Profunda Artery Perforating Arteries before Free Flap Breast Reconstruction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005132.html