Application of CT angiography in delayed DIEP flap breast reconstruction

doi:10.19401/j.cnki.1007-3639.2022.02.004

Abstract

Abstract:

Background and purpose: Deep inferior epigastric perforator (DIEP) is attracting increasing attention in breast reconstruction surgery. How to safely and effectively locate, choose and anatomize perforating vessels is a huge challenge for the preparation of DIEP flaps. This study aimed to explore the value of computed tomographic angiography (CTA) in delayed DIEP reconstruction after breast cancer surgery. Methods: From January 2016 to January 2021, 298 patients underwent delayed DIEP flap breast reconstruction surgery in The Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 92 cases were set as the control group (US group), and the perforation of the flap was evaluated by ultrasound doppler before surgery. A total of 206 cases were selected as the observation group (CTA group). Preoperative perforation of the flap was evaluated by CTA, and the CTA data were imported into HOROS software for processing and analysis, so as to select the preoperatively dominant perforation of the flap and identify the anatomical information such as the diameter of perforation vessel, the way of intramural movement and the position of perforation point, for directing operation. The number of preoperative location perforations, number of intraoperative choice perforations, perforation choice time, perforation anatomy time, donor site flap acquisition time, flap weight, total operation time and incidence of postoperative complications (abdominal incision infection rate, fat necrosis rate, secondary surgical exploration rate and complete flap necrosis rate) were compared and analyzed between the two groups. And the consistency rate of imaging surgery was compared between the two groups. Results: All the 298 patients underwent delayed DIEP flap breast reconstruction, and the flap survival rate was 99.3% (296/298). The number of preoperative located perforations in the two groups was: CTA group (2.90±1.13) vs US group (3.21±1.46) (P<0.05). The acquisition time of donor flap was (50.05±10.94) min vs (84.8±15.44) min (P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). In the comparison of the second surgical exploration rate, the CTA group was lower than the US group (P<0.001). For patients with a history of abdominal surgery, the perforator anatomical time and total operation time in the CTA group were better compared with the US group (P<0.001). The coincidence rates of imaging surgery in the two groups were 97.09% and 43.48%, respectively, with statistical significance (P<0.001). Conclusion: In delayed DIEP flap breast reconstruction, CTA can significantly shorten the choice time of flap perforation and anatomy time, reduce the risk of secondary surgical exploration and has a high rate of image surgery consistency, which can effectively guide the operation.

Key words: Computed tomographic angiography, Deep inferior epigastric perforator, Breast reconstruction, Delayed, Breast cancer

CLC Number:

R737.9

XU Hua, LIU Ying, ZHANG Yi, WANG Tingliang, WANG Tao, HE Jinguang, LUO Jie, DONG Liping, WANG Hairong, DONG Jiasheng, XU Yuanbing. Application of CT angiography in delayed DIEP flap breast reconstruction[J]. China Oncology, 2022, 32(2): 125-133.

Figures/Tables 10

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Factors	CTA group	US group	F/χ²	P value
Age/year	41.78±9.06	40.94±8.61	1.25	0.27
BMI	24.34±3.20	24.21±2.86	0.71	0.40
Basic disease			0.098	0.754
With	25	10
Without	181	82
Chemotherapy			0.281	0.596
With	158	69
Without	48	23
Chest-wall radiotherapy			0.001	0.977
With	72	32
Without	134	60
Abdominal surgery			0.264	0.608
With	82	36
Without	124	56
Smoking			0.017	0.895
Yes	4	2
No	202	90
Blood supply of flap			0.128	0.720
Unipedicle	85	40
Bipedicle	121	52

Indicators	CTA group	US group	F/χ²	P value
Number of preoperative location perforations	2.90±1.13	3.21±1.46	6.460	0.012
Number of intraoperative choice perforations	2.26±0.92	2.49±0.96	0.907	0.342
Perforation choice time t/min	9.14±3.38	26.73±6.54	49.420	<0.001
Perforation anatomy time t/min	40.92±9.98	58.11±14.44	19.640	<0.001
Donor site flap acquisition time t/min	50.05±10.94	84.80±15.44	15.560	<0.001
Flap weight m/g	730.62±127.31	718.25±129.36	0.005	0.942
Total operation time t/min	294.20±68.51	328.74±68.69	0.058	0.809
Abdominal incision infection			0.199	0.656
Yes	3	2
No	203	90
Fat necrosis			0.404	0.525
Yes	6	4
No	200	88
Secondary surgical exploration			11.501	<0.001
Yes	6	12
No	200	80
Complete flap necrosis
Yes	0	2		0.095
No	206	90

Groups	Perforation anatomy time t/min	P value	Total operation time t/min	P value
① CTA+NAS	32.06±7.96	0.023^a	288.46±58.34	0.040^e
② CTA+AS	42.36±10.06	<0.001^b	300.06±60.29	0.018^f
③ US+NAS	50.98±13.02	<0.001^c	304.78±64.58	0.248^g
④ US+AS	68.30±15.08	0.012^d	332.03±70.28	0.014^h