Soliman Mahmoud, Metwally Islam H, Denewer Adel, Abdallah Ahmed, Denewar Fatmaelzahraa Abdelfattah, Healy Nuala Ann, Romics Laszlo, Agrawal Amit
North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, M8 5RB, United Kingdom.
Surgical Oncology Department, Faculty of Medicine, Mansoura University, 35516, Egypt.
Br J Radiol. 2025 Jan 1;98(1165):27-35. doi: 10.1093/bjr/tqae203.
Thoraco-dorsal artery perforator (TDAP) flaps have been increasingly used in breast and soft tissue reconstruction. Perforator localization is often done using a hand-held doppler, however, false results are not uncommon. This study aimed to systematically review the literature on the value of preoperative computed tomographic angiography (CTA) in TDAP flaps examining scanning protocol, mapping technique, concordance with operative findings, and disadvantages.
A PRISMA-compliant comprehensive search of Medline, Embase, Cochrane Library, and CINAHL databases was conducted in November 2023. We included studies evaluating CTA mapping of free and pedicled TDAPs for breast or soft tissue reconstruction using The Joanna Briggs Institute (JBI) Critical Appraisal Tools.
Five studies were included and considered at high risk of bias. The studies included 72 patients with a mean age of 43.8 years. Concordance between CT findings and Doppler mapping or operative visualization was reported in two studies. In three studies, CTA was combined with Doppler flowmetry, whilst dynamic infrared thermography was used in one study. Standardized scanning protocol and patient positioning were lacking in all reports.
This study highlights the paucity of evidence on the value of CTA in TDA perforator mapping with inconsistent outcomes and non-standardized scanning protocols. Despite difficult imaging acquisition and interpretation, 3D reconstructed images and detailed vascular anatomy may facilitate planning.
Further research is required to explore the practical value of CTA in TDAP planning and standardizing protocols.
胸背动脉穿支（TDAP）皮瓣越来越多地用于乳房和软组织重建。穿支定位通常使用手持式多普勒仪进行，然而，出现错误结果的情况并不少见。本研究旨在系统回顾关于术前计算机断层血管造影（CTA）在TDAP皮瓣中的价值的文献，研究扫描方案、定位技术、与手术结果的一致性以及缺点。
2023年11月对Medline、Embase、Cochrane图书馆和CINAHL数据库进行了符合PRISMA标准的全面检索。我们纳入了使用乔安娜·布里格斯研究所（JBI）批判性评估工具评估游离和带蒂TDAP用于乳房或软组织重建的CTA定位的研究。
纳入了五项研究，这些研究被认为存在高偏倚风险。这些研究包括72例患者，平均年龄为43.8岁。两项研究报告了CT结果与多普勒定位或手术可视化之间的一致性。在三项研究中，CTA与多普勒血流测定相结合，而在一项研究中使用了动态红外热成像。所有报告均缺乏标准化的扫描方案和患者体位。
本研究强调了关于CTA在TDA穿支定位中的价值的证据不足，结果不一致且扫描方案不标准化。尽管图像采集和解读困难，但三维重建图像和详细的血管解剖结构可能有助于手术规划。
需要进一步研究以探索CTA在TDAP规划中的实际价值并规范方案。
