Evaluating the Best Use of 3D CT Angiograms in Free Abdominal Breast Reconstruction: Do fewer perforators correlate larger vessels?
Joseph M. Zakhary, MD1, Abby Threet, BS2, Tim King, MD, PHD2, Jorge de la Torre, MD, MSHA2, Matt Mino, MD2, Ashley Thorburn, MD2.
1University of Alabama at Birmingham, Hoover, AL, USA, 2University of Alabama at Birmingham, Birmingham, AL, USA.
PURPOSE: Autologous Microvascular Breast Reconstruction at the present time revolves around abdominal based Free Tissue Transfer. A 3D CTA is a commonly used in preoperative planning to identify the perforators and intact pedicle supplying the proposed flap. Based on flow mechanics one would hypothesize that as the number of perforators increase that the average size of each of the given perforators would decrease.
METHODS: One hundred charts of patients who underwent free abdominal breast reconstruction were reviewed, specifically examining CT angiograms with 3D reconstruction. The following data was collected: quantity, locations, and diameters of perforators, patient BMI, and pre-operative blood pressure. A sub group of Perforators within 3 cm superior and 5 cm inferior to umbilicus were of special interest, as this anatomical region is most commonly used for DIEP flaps. A Pearsons correlation coefficient and Students Two sided Test were used to evaluate the data.
RESULTS: Contrary to our original hypothesis, we found that as perforator number increased as did the average perforator size (Pearson correlation coefficient of 0.31 on the left and 0.17 on the right, CI 99.9% and 95%). This led us to investigate the relationship of pre-operative BMI and mean arterial pressure with average vessel diameter. A larger BMI resulted in a larger average vessel diameter (Pearson correlation coefficient of 0.293 for the left and 0.286 on the right with CI of 99.5% for both). Blood pressure showed no statistical correlation with vessel size or number. One of the strongest and most unique findings was the correlation between vessel diameters in our subgroup and the total vessel number from the DIEA.
CONCLUSION: The evaluation of the CTA and data revealed several interesting findings. It would make sense that there is no correlation between vessel number and BMI as perforators must pierce the fascia to supply the abdominal soft tissue and it would be difficult to believe this value changes throughout a patients lifetime. However, the correlation between vessel number and diameter was not inverse as initially proposed, it was the opposite. Vessel Diameter increased with BMI to most likely meet the demands of increased blood flow required to supply the larger amount of abdominal soft tissue. The subgroup (area most likely used to harvest an abdominal free flap perforator) correlated strongly with BMI and strangely with overall number of perforators on its respective side, but not with the number of perforators within the zone. These findings can help in surgical planning for free abdominal flap reconstruction.
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