Arch Plast Surg.
2020 Mar;47(2):146-152. 10.5999/aps.2019.00801.
Implications of abnormal abdominal wall computed tomographic angiography findings on postmastectomy free flap breast reconstruction
- Affiliations
-
- 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
- 2Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- 3Plastic and Reconstructive Surgery Unit, Alexandria Medical School, Alexandria University, Alexandria, Egypt
- 4Department of Radiology and Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- 5Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- 6Anglia Ruskin University School of Medicine, Chelmsford, UK
- KMID: 2501153
- DOI: http://doi.org/10.5999/aps.2019.00801
Abstract
- Background
Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan.
Methods
We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected.
Results
Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were “miscellaneous.” In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation.
Conclusions
CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Autologous Microvascular Breast Reconstruction
- Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma
- Breast Reconstruction with Lower Abdominal Tissue Free Transfer
- Progress of Techniques in Breast Reconstruction Using Autologous Abdominal Tissue
- Reconstruction of an abdominal wall defect using a latissimus dorsi musculocutaneous free flap after high-intensity focused ultrasound: a case report
