Computed Tomographic Angiography in Planning Thoraco-dorsal Artery Perforator Flap in Breast and Soft Tissue Reconstruction: A Systematic Review.

Objectives: Thoraco-dorsal Artery Perforator (TDAP) flaps have been increasingly used in breast and soft tissue reconstruction. Perforator localization is often done using a hand-held doppler, however, false results are not uncommon. This study aimed to systematically review the literature on the value of preoperative Computed Tomographic Angiography (CTA) in TDAP flaps examining scanning protocol, mapping technique, concordance with operative findings and disadvantages.

Methods: A PRISMA-compliant comprehensive search of Medline, Embase, Cochrane Library and CINAHL databases was conducted in November 2023. We included studies evaluating CTA mapping of free and pedicled TDAPs for breast or soft tissue reconstruction using The Joanna Briggs Institute (JBI) Critical Appraisal Tools.

Results: Five studies were included and considered at high risk of bias. The studies included 72 patients with a mean age of 43.8 years. Concordance between CT findings and Doppler mapping or operative visualization was reported in two studies. In three studies, CTA was combined with Doppler flowmetry, whilst dynamic infrared thermography was used in one study. Standardized scanning protocol and patient positioning were lacking in all reports.

Conclusions: This study highlights the paucity of evidence on the value of CTA in TDA perforator mapping with inconsistent outcomes and non-standardized scanning protocols. Despite difficult imaging acquisition and interpretation, 3D reconstructed images and detailed vascular anatomy may facilitate planning.

Advances in knowledge: Further research is required to explore the practical value of CTA in TDAP planning and standardizing protocols.