Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Switzerland; Breast Center, University Hospital Basel, Switzerland.
Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Switzerland.
J Plast Reconstr Aesthet Surg. 2019 Oct;72(10):1632-1639. doi: 10.1016/j.bjps.2019.06.008. Epub 2019 Jul 6.
Preoperative imaging by Computed Tomographic Angiography (CTA) has been promoted a gold standard tool for perforator mapping in abdominally based microsurgical breast reconstruction, while Color Doppler Ultrasound (CDU) has lost its popularity. As the CTA X-ray exposure might have long-term consequences for patients, CDU has regained importance for preoperative workup in our center. Our aim was to revisit the role of CDU by comparing the reliability of CDU and CTA in predicting intraoperative perforator selection.
We performed a retrospective chart review study of patients who underwent microsurgical breast reconstructions with DIEP flaps at our institution. Both CTA and CDU were performed prior to the surgery, and both imaging entities were thoroughly examined by the surgical team. Perforator identification, number, size, and location were assessed and correlated with CTA and CDU data and with intraoperative findings.
We identified 98 patients who received 125 DIEP flap surgeries. A significantly stronger correlation was found between CDU and intraoperative findings of perforator detection and size (p<0.0001) and selection (r = 0.9987, CI 0.9981-0.9991, p < 0.0001 and r = 0.01, CI -0.18-0.2, p = 0.91, respectively), when compared with CTA data. If none of the preoperative imaging studies matched intraoperative perforator selection, an association with a higher incidence of flap loss (Odds ratio 4.483, CI 0.5068-39.65, p = 0.2171) was found.
Our data suggests that CDU might regain relevance as a safe and reliable preoperative imaging study, without the risk and potential consequences of X-ray exposure. Preoperative imaging tools like CDU and CTA should be considered part of the gold standard in abdominally based free flap breast reconstruction.
计算机断层血管造影（CTA）术前成像已被推广为腹部显微乳房重建中穿支定位的金标准工具，而彩色多普勒超声（CDU）已失去其普及度。由于 CTA 的 X 射线照射可能对患者造成长期影响，CDU 在我们中心的术前检查中重新变得重要。我们的目的是通过比较 CDU 和 CTA 在预测术中穿支选择中的可靠性，重新审视 CDU 的作用。
我们对在我院接受 DIEP 皮瓣显微乳房重建的患者进行了回顾性图表审查研究。手术前均进行 CTA 和 CDU 检查，手术团队对两种影像学实体均进行了详细检查。评估了穿支的识别、数量、大小和位置，并与 CTA 和 CDU 数据以及术中发现相关联。
我们确定了 98 名接受 125 例 DIEP 皮瓣手术的患者。与 CTA 数据相比， CDU 与术中发现的穿支检测和大小（p<0.0001）以及选择（r = 0.9987，CI 0.9981-0.9991，p<0.0001 和 r = 0.01，CI -0.18-0.2，p = 0.91）之间的相关性更强。如果术前影像学研究均与术中穿支选择不匹配，则与更高的皮瓣失活发生率相关（优势比 4.483，CI 0.5068-39.65，p = 0.2171）。
我们的数据表明，CDU 可能会重新成为一种安全可靠的术前影像学检查手段，而不会有 X 射线照射的风险和潜在影响。像 CDU 和 CTA 这样的术前成像工具应被视为腹部游离皮瓣乳房重建的金标准的一部分。
