Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction

Autor: Hummelink, S., Hofer, S., Hameeteman, M., Hoogeveen, Y., Slump, Cornelis H., Ulrich, D.J.O., Schultze Kool, L.J.
Rok vydání: 2014
Předmět:
EWI-25448
medicine.medical_specialty
Microsurgery
reconstruction
METIS-309740
Mammaplasty
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
symbols.namesake
IR-94230
Imaging
Three-Dimensional
DIEP flap
DIEP flap breastreconstruction
Image Interpretation
Computer-Assisted
medicine
Humans
Computed tomography angiography
medicine.diagnostic_test
business.industry
Other Research Radboud Institute for Health Sciences [Radboudumc 0]
Abdominal Wall
DIEP flap breast
Ultrasonography
Doppler
Gold standard (test)
Fascia
Epigastric Arteries
Surgery
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
Transplantation
Computer tomography angiography
medicine.anatomical_structure
Surgery
Computer-Assisted
Perforator mapping
symbols
Female
Pico video projector
Radiology
business
Breast reconstruction
Tomography
X-Ray Computed
Virtual planning
Doppler effect
Perforator Flap
Artery
Zdroj: Journal of Plastic, Reconstructive and Aesthetic Surgery, 68, 3, pp. 390-4
Journal of plastic, reconstructive & aesthetic surgery, 2014(3), 390-394. Churchill Livingstone
Journal of Plastic, Reconstructive and Aesthetic Surgery, 68, 390-4
ISSN: 1878-0539
1748-6815
Popis: Item does not contain fulltext INTRODUCTION: In a deep inferior epigastric perforator (DIEP) flap breast reconstruction, computed tomography angiography (CTA) is currently considered as the gold standard in preoperative imaging for this procedure. Unidirectional Doppler ultrasound (US) is frequently used; however, this method does not distinguish the main axial vessels from perforator arteries at the height of the fascia, it has a limited penetration depth, and it cannot assess the branching patterns of the deep inferior arteries. A new method and system were developed, which consisted of a video projector preoperatively displaying the location and intramuscular course of the artery perforators and subcutaneous branching on the patient's abdomen. METHOD: All patients (n = 9) underwent a standard protocol: a preoperative CTA was performed and the DIEPs were localized using a unidirectional Doppler probe. In addition, a three-dimensional (3D) reconstruction of the perforator locations based on CTA was projected on the abdomen of the patients. All projected perforator locations were assessed using a unidirectional Doppler probe. The intraoperative results were collected for comparison. RESULTS: A total of 88 locations were marked with the use of unidirectional Doppler and a total of 100 perforators were projected (p = 0.38). In 98 out of 100 projected perforator locations, a Doppler signal was audible. The intraoperative results demonstrate that 19 out of 34 transplanted perforators were correctly identified with unidirectional Doppler (56.9% +/- 31.4%), where the projection method properly revealed 29 locations (84.3% +/- 25.8%) (p = 0.030). CONCLUSION: The projection method is not only capable of providing more information and identifying more perforators used for transplantation than unidirectional Doppler probing but also more accurate in pointing out the corresponding perforator found intraoperatively.
Databáze: OpenAIRE
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