Eder Maximilian, Raith Stefan, Jalali Jalil, Müller Daniel, Harder Yves, Dobritz Martin, Papadopulos Nikolaos A, Machens Hans-Günther, Kovacs Laszlo
Research Group-Computer Aided Plastic Surgery (CAPS), Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , Munich, Germany,
Int J Comput Assist Radiol Surg. 2014 Jul;9(4):541-9. doi: 10.1007/s11548-013-0941-4. Epub 2013 Oct 5.
The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction.
Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes ([Formula: see text]) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed.
40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, [Formula: see text]), allowing a prediction accuracy within 0.29 [Formula: see text] 3.0 % (range: from [Formula: see text]8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes ([Formula: see text]), leading to an average of 21 % of the remnant flap tissue potentially being discarded.
CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry.
将计算机断层血管造影（CTA）用于识别腹部游离皮瓣乳房重建的穿支血管的诊断用途扩展至估计术前三维（3D）皮瓣体积，并将其与术中实际皮瓣重量进行比较，以（1）评估基于CTA的3D皮瓣体积预测的准确性，以及（2）分析用于所需乳房体积重建的腹部组织估计情况。
对54例行单侧乳房重建且采用游离、腹壁下深动脉穿支皮瓣的患者进行术前CTA检查。计算基于CTA数据的3D皮瓣体积（[公式：见原文]），并与术中实际皮瓣重量（克）进行比较。此外，计算乳房体积与皮瓣体积之比，以分析估计的3D腹部皮瓣体积是否与拟切除乳房的体积相匹配。
40个CTA数据集（74.1%）满足可靠测定皮瓣体积的技术要求。3D CTA皮瓣体积预测与实际皮瓣重量无显著差异（p = 0.44）且相关性高（r = 0.998，[公式：见原文]），预测准确率在实际皮瓣重量的0.29 [公式：见原文] 3.0%范围内（范围：从[公式：见原文]-8.77至5.67%）。与实际所需乳房体积相比，获取的皮瓣体积明显更大（[公式：见原文]），导致平均有21%的剩余皮瓣组织可能被丢弃。
基于CTA的3D皮瓣体积预测可为获取可接受对称性所需的腹部组织量提供准确的术前指导。
