Seattle, Wash. From the Division of Plastic Surgery, University of Washington Medical Center.
Plast Reconstr Surg. 2010 Feb;125(2):446-453. doi: 10.1097/PRS.0b013e3181c82d24.
To plan abdominal perforator-based microsurgical breast reconstruction, duplex ultrasound is often employed to preoperatively identify the location of abdominal wall perforating vessels. Recently, several groups have published the use of computed tomography angiography for preoperative planning in perforator flap breast reconstruction. The purpose of this study was to compare the accuracy of computed tomography angiography in locating clinically useful abdominal wall perforators with that of duplex ultrasound.
A prospective study was conducted of 22 consecutive patients undergoing 30 abdomen-based microsurgical breast reconstructions using both preoperative computed tomography angiography and duplex ultrasound. Perforator data were obtained with both computed tomography angiography and ultrasound. The two largest perforators were chosen per abdominal side for comparison between studies. In addition, the locations of perforators were confirmed at surgery.
Computed tomography angiography preoperatively identified 83 of the largest perforators, while only 55 of these large perforators (66.3 percent) were preoperatively identified on ultrasound. No superficial inferior epigastric arteries were identified by ultrasound. However, in all eight breast reconstructions performed with the superficial inferior epigastric system, the superficial inferior epigastric arteries were identified preoperatively as adequate size for microsurgical transfers, with an average diameter of 1.6 mm.
There are many advantages to preoperative computed tomography angiography for planning abdominal perforator-based microsurgical breast reconstruction, including accurate identification of perforating vessels, the underlying branching pattern of the deep inferior epigastric artery, and the presence of the superficial inferior epigastric vessels. This study demonstrates the superiority of computed tomography angiography over duplex ultrasound as a tool for preoperative planning of perforator-based breast reconstruction.
为了规划基于腹部穿支的显微乳房再造，常采用双功能超声来术前确定腹壁穿支血管的位置。近来，一些研究小组发表了使用计算机断层血管造影术（CTA）进行穿支皮瓣乳房再造术前规划的文章。本研究的目的是比较 CTA 定位临床有用腹壁穿支的准确性与双功能超声的准确性。
前瞻性研究了 22 例连续患者，对 30 例腹部为基础的显微乳房再造术同时使用术前 CTA 和双功能超声。用 CTA 和超声获取穿支数据。每侧腹部选择 2 个最大的穿支进行研究比较。此外，在手术中确认穿支的位置。
CTA 术前确定了 83 个最大的穿支，而这些大穿支中只有 55 个（66.3%）在超声术前确定。超声未识别出腹壁浅动脉。然而，在所有 8 例采用腹壁浅动脉系统的乳房再造中，腹壁浅动脉在术前均被识别为适合显微转移的大小，平均直径为 1.6mm。
术前 CTA 对规划基于腹部穿支的显微乳房再造有许多优势，包括准确识别穿支血管、深腹壁下动脉的分支模式和腹壁浅动脉的存在。本研究表明 CTA 作为穿支乳房再造术前规划工具优于双功能超声。
