Ngaage Ledibabari Mildred, Hamed Raed R, Oni Georgette, Ghorra Dina T, Ang Jolenda Z, Koo Brendan C, Benyon Sarah L, Irwin Michael S, Malata Charles M
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Arch Plast Surg. 2020 Mar;47(2):146-152. doi: 10.5999/aps.2019.00801. Epub 2020 Mar 15.
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.
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.
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.
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.
在计划游离皮瓣乳房重建术（FFBR）时，会使用腹壁血管的术前计算机断层血管造影（CTA），因为它能提供一份手术路线图，便于皮瓣切取。然而，关于异常发现对手术计划影响的报道较少。
我们对一家三级转诊中心在6年期间（2011年11月至2017年6月）进行的所有FFBR进行了回顾性研究。由一位放射科顾问医师报告检查结果。收集了患者人口统计学、CTA报告及术中细节的相关信息。
200例患者接受了术前CTA检查。14%的患者（n = 28）有异常发现。在这些发现中，18%为血管异常；36%与肿瘤相关，46%为“其他”。4例患者的检查结果随后导致手术无法进行；包括肠系膜动脉瘤、腹壁下深动脉（DIE）缺如、双侧DIE动脉闭塞以及严重骨转移。另1例患者没有适合游离皮瓣的血管，手术计划改为带蒂腹直肌肌皮瓣。其余偶然发现对手术计划或FFBR的适宜性没有影响。超过十分之一有异常发现的患者在手术前还进行了进一步的影像学检查。
FFBR中的CTA可能产生比促进手术规划和减少手术时间更广泛的影响。偶然发现可能影响手术计划，在某些情况下，可避免注定失败和不安全的手术。因此，由经验丰富的放射科医师报告这些扫描结果很重要。
