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European Surgery
Published in: European Surgery 6/2016

Open Access 01-12-2016 | original article

Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction

Authors: K. F. Schrögendorfer, M.D., S. Nickl, M.D., M. Keck, M.D., D. B. Lumenta, M.D., C. Loewe, M.D., M. Gschwandtner, M.D., W. Haslik, M.D., J. Nedomansky, M.D.

Published in: European Surgery | Issue 6/2016

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Summary

Background

Autologous breast reconstruction is an integral part in the treatment of breast cancer. While computed tomography angiography (CTA) is an established preoperative diagnostic tool for microsurgeons, no study has so far evaluated and compared five different imaging methods and their value for the reconstructive team. In order to determine the feasibility of each of the tools for routine or specialized diagnostic application, the methods’ efficiency and informative value were analyzed.

Methods

We retrospectively analyzed imaging data of 41 patients used for perforator location and assessment for regional perfusion and vessel patency in patients undergoing autologous breast reconstruction with deep inferior epigastric perforator flap (DIEP), transverse rectus abdominis muscle flap (TRAM), or transverse myocutaneous gracilis flap (TMG). Five different imaging techniques were used: hand held Doppler (HHD), CT angiography (CTA), macroscopic indocyanine green (ICG) video angiography, microscope-integrated ICG video angiography, and laser Doppler imaging (LDI).

Results

CTA proved to be the best tool for preoperative determination of the highly variable anatomy of the abdominal region, whereas HHD showed the same information on perforator localization with some false-positive results. Intraoperative HHD was an excellent tool for dissection and vessel patency judgment. Microscope-integrated ICG was an excellent tool to document the patency of microanastomoses. In our series, macroscopic perfusion measurement with ICG or LDI was only justified in special situations, where information on perfusion of abdominal or mastectomy flaps was required. LDI did not add any additional information.

Conclusion

Preoperative assessment should be performed by CTA with verification of the perforator location by HHD. Intraoperative HHD and microscope-integrated ICG contribute most toward the evaluation of vessel patency. ICG and LDI should only be used for special indications.
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Metadata
Title
Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
Authors
K. F. Schrögendorfer, M.D.
S. Nickl, M.D.
M. Keck, M.D.
D. B. Lumenta, M.D.
C. Loewe, M.D.
M. Gschwandtner, M.D.
W. Haslik, M.D.
J. Nedomansky, M.D.
Publication date
01-12-2016
Publisher
Springer Vienna
Published in
European Surgery / Issue 6/2016
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-016-0449-6

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