腹壁下动脉穿支皮瓣乳房重建的效率：计算机断层血管造影成像的真正益处。
Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging.
机构信息
From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
出版信息
Plast Reconstr Surg. 2020 Oct;146(4):719-723. doi: 10.1097/PRS.0000000000007148.
BACKGROUND
In deep inferior epigastric perforator (DIEP) flap breast reconstruction, many surgeons use preoperative imaging for perforator mapping as a method to plan the operation, reduce operative times, and potentially limit morbidity. This study compared operative times for specific portions of DIEP flap harvest with and without preoperative computed tomographic angiography imaging.
METHODS
Two patient groups undergoing DIEP flap breast reconstruction were studied prospectively. In the experimental group, the harvesting surgeon was blinded to the preoperative computed tomographic angiography scan; in the control group, the harvesting surgeon assessed the scan preoperatively. Times for initial perforator identification, perforator selection, flap harvest time, and total procedure times were compared. Perforator choice was evaluated. Correlation of perforator choice preoperatively and intraoperatively was also performed.
RESULTS
Times were recorded in 60 DIEP flaps (27 blinded and 33 unblinded). The nonblinded group was more efficient in all categories: time to first perforator identification (28.6 minutes versus 17.8 minutes; p < 0.0001), time to perforator decision-making (23.1 minutes versus 5.6 minutes; p < 0.0001), time to flap harvest (128 minutes versus 80 minutes; p < 0.0001), and total operative time (417 minutes versus 353 minutes; p < 0.001). Perforator location was not different between groups. Blinded intraoperative decisions correlated with preoperative imaging in 74 percent of flaps. More perforators were included in the blinded flaps compared to the nonblinded flaps (2.3 versus 1.4; p < 0.001).
CONCLUSIONS
Use of preoperative computed tomographic angiography leads to decreased operative times, specifically with regard to perforator identification and perforator selection. Without preoperative computed tomographic angiography, surgeons included more perforators in the flaps.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
背景
在深部腹壁下动脉穿支（DIEP）皮瓣乳房重建中，许多外科医生使用术前影像学进行穿支定位，以规划手术，减少手术时间，并降低潜在的发病率。本研究比较了 DIEP 皮瓣采集过程中特定部分在使用和不使用术前 CT 血管造影成像时的手术时间。
方法
前瞻性研究两组接受 DIEP 皮瓣乳房重建的患者。在实验组中，采集外科医生对术前 CT 血管造影扫描不知情；在对照组中，采集外科医生术前评估扫描。比较首次穿支识别、穿支选择、皮瓣采集时间和总手术时间。评估穿支选择。还对术前和术中穿支选择的相关性进行了评估。
结果
60 例 DIEP 皮瓣（27 例盲法和 33 例非盲法）记录时间。非盲组在所有类别中效率更高：首次穿支识别时间（28.6 分钟对 17.8 分钟；p < 0.0001）、穿支决策时间（23.1 分钟对 5.6 分钟；p < 0.0001）、皮瓣采集时间（128 分钟对 80 分钟；p < 0.0001）和总手术时间（417 分钟对 353 分钟；p < 0.001）。两组之间穿支位置无差异。盲法术中决策与术前影像学在 74%的皮瓣中相关。与非盲法皮瓣相比，盲法皮瓣纳入的穿支更多（2.3 对 1.4；p < 0.001）。
结论
使用术前 CT 血管造影可缩短手术时间，特别是在穿支识别和穿支选择方面。如果没有术前 CT 血管造影，外科医生会在皮瓣中纳入更多的穿支。
临床问题/证据水平：治疗性，II 级。
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