Casey William J, Chew Roderick T, Rebecca Alanna M, Smith Anthony A, Collins Joseph M, Pockaj Barbara A
Phoenix, Ariz. From the Division of Plastic and Reconstructive Surgery, the Department of Radiology, and the Department of General Surgery, Mayo Clinic Arizona.
Plast Reconstr Surg. 2009 Apr;123(4):1148-1155. doi: 10.1097/PRS.0b013e31819e23e1.
Preoperative computed tomography has been used to facilitate deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction. This study identifies the improvements in outcome that this may provide.
A retrospective review of a consecutive series of DIEAP and superficial inferior epigastric artery (SIEA) flap breast reconstructions was performed over 5 years. All patients underwent hand-held Doppler interrogation of the abdomen. Patient demographics, operative times, and postoperative outcomes were compared before and after the routine use of computed tomographic imaging.
Two hundred eighty-seven flaps were performed on 213 patients. There were 139 unilateral and 74 bilateral reconstructions, with 168 flaps performed immediately after mastectomy and 119 flaps performed in a delayed setting. One hundred one flaps were performed with computed tomographic imaging, whereas 186 flaps followed hand-held Doppler interrogation alone. Mean follow-up was 24 months. The use of computed tomography had a beneficial impact on operative times (unilateral, 370 versus 459 minutes; bilateral, 515 versus 657 minutes; p < 0.05), number of perforators included (1.5 versus 1.9; p < 0.05), and abdominal bulges (1 percent versus 9.1 percent; p < 0.05). Anastomotic complications (6.9 percent versus 8.1 percent), failure rates (2 percent versus 3.8 percent), fat necrosis (10.9 percent versus 13.4 percent), and abdominal wounds (11.8 percent versus 16.6 percent) were not found to be significantly different. Computed tomography did identify three cases of deep inferior epigastric vessel ligation from previous operations, which compromised these as suitable source vessels.
This study suggests that preoperative computed tomography leads to decreased operative times and a reduction in abdominal bulge rates, and may reduce the learning curve in DIEAP breast reconstruction compared with hand-held Doppler evaluation alone.
术前计算机断层扫描已被用于辅助腹壁下动脉穿支（DIEAP）皮瓣乳房重建。本研究确定了这可能带来的结果改善。
对连续5年的一系列DIEAP和腹壁浅动脉（SIEA）皮瓣乳房重建进行回顾性研究。所有患者均接受腹部手持多普勒检查。比较了常规使用计算机断层扫描成像前后的患者人口统计学、手术时间和术后结果。
对213例患者进行了287例皮瓣手术。其中139例为单侧重建，74例为双侧重建，168例皮瓣在乳房切除术后立即进行，119例皮瓣为延迟手术。101例皮瓣手术使用了计算机断层扫描成像，而186例皮瓣仅采用手持多普勒检查。平均随访时间为24个月。使用计算机断层扫描对手术时间（单侧，370分钟对459分钟；双侧，515分钟对657分钟；p<0.05）、包含的穿支数量（1.5对1.9；p<0.05）和腹部膨出（1%对9.1%；p<0.05）有有益影响。吻合口并发症（6.9%对8.1%）、失败率（2%对3.8%）、脂肪坏死（10.9%对13.4%）和腹部伤口（11.
