K F Schrögendorfer, S Nickl, M Keck, D B Lumenta, C Loewe, M Gschwandtner, W Haslik, J Nedomansky
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引用次数: 12
Abstract
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.
期刊介绍：
The journal European Surgery – Acta Chirurgica Austriaca focuses on general surgery, endocrine surgery, thoracic surgery, heart and vascular surgery. Special features include new surgical and endoscopic techniques such as minimally invasive surgery, robot surgery, and advances in surgery-related biotechnology and surgical oncology.
The journal especially addresses benign and malignant esophageal diseases, i.e. achalasia, gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma. In keeping with modern healthcare requirements, the journal’s scope includes inter- and multidisciplinary disease management (diagnosis, therapy and surveillance).
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