Optimization in DIEP flap breast reconstruction (deep inferior epigastric artery perforator flap) with the help of CT(A) and 3D mapping

Abstract

Introduction: deep inferior epigastric perforator flap (DŒP-flap) reconstruction provides the most acceptable aesthetic result among autologous breast reconstruction. However, a thorough preoperative assessment of the individual vascular anatomy of the deep lower epigastric vessels (DIEA/V) is still challenging. Usage of CT(a) allows define individual anatomical features such as: intramuscular stroke, tortuosity of vessels and their branches which is an essential thing for reducing of the operation time, flap ischemia time, decreasing the complication rate. Material and methods: with the help of Radiology Department, we have launched a new protocol for planning of the DIEP flap surgery. As a preoperative preparation, we perform CT angiography (CTA) according to a specific protocol, which allows us to reduce the trauma of aponeurosis and the rectus abdominis muscle. Conclusion: preoperative CT angiography, performed according to a special scanning and post-processing protocol, allows us to optimize the planning of the surgical intervention and improving the results of breast reconstruction. Detailed study of the topography of the vessels of the anterior abdominal wall leads to a decrease in tissue injury of the anterior abdominal wall. This article describes the importance of CT angiography, for the preoperative preparation (visualization) as a crucial step in preparing for the DIEP reconstruction of the breast.