PR11PREOPERATIVE IMAGING FOR DIEA PERFORATOR FLAPS: A COMPARATIVE STUDY OF CT ANGIOGRAPHY AND DOPPLER ULTRASOUND

Abdominal donor site flaps, including the Transverse Rectus Abdominis Musculocutaneous (TRAM) and Deep Inferior Epigastric Artery (DIEA) perforator flaps, are the standard in autologous breast reconstruction. With variation in the vascular anatomy of the abdominal wall, preoperative imaging is essential for preoperative planning and reducing intraoperative error. Ultrasound has been used previously with varying results, and the quest continues for optimal preoperative assessment. Computerised Tomography Angiography (CTA) has been recently proposed as a non-invasive modality for this purpose. This is the first study to formally compare preoperative Doppler ultrasound with CTA for imaging the DIEA. Eight consecutive patients undergoing DIEA perforator flaps for breast reconstruction undertook both CTA and Doppler ultrasound preoperatively. All investigations and procedures were undertaken at the same institution with the same surgeon and radiology team. CTA was superior at identifying the course of the DIEA, its branching pattern and in visualizing its perforators than Doppler ultrasound. Preoperative CTA was highly specific (100%) and more sensitive in mapping and visualising perforators (p < 0.001). CTA was also proficient at identifying the superficial epigastric arterial system and for effectively displaying the results intraoperatively. CTA was substantially quicker and removed the inter-observer error associated with Doppler ultrasonography. The study was ceased after eight patients due to the overwhelming benefit of CTA over Doppler. CTA is a valuable imaging modality for the preoperative assessment of the donor site vascular supply for TRAM and DIEA perforator flaps. [PUBLICATION ABSTRACT]