Perforator Mapping Practice for Deep Inferior Epigastric Artery Perforator Flap Reconstructions
| Autor: | Michiel R. Beets, Jan J. van Wingerden, Carolien F. Wever, Moustapha Hamdi, Pauline D. Verhaegen, Vivian B. Boer |
|---|---|
| Přispěvatelé: | Surgical clinical sciences, Plastic Surgery, Plastic, Reconstructive and Hand Surgery, Other Research |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
reconstruction Computed Tomography Angiography Mammaplasty Statistical difference 030230 surgery Routine practice DIEP Deep Inferior Epigastric Artery Perforator Flap surgery 03 medical and health sciences 0302 clinical medicine DIEP flap medicine perforator breast reconstruction survey mapping BENELUX Computed tomography angiography medicine.diagnostic_test business.industry General surgery Deep Inferior Epigastric Artery Perforator Mapping Practice Epigastric Arteries Plastic surgery Current practice 030220 oncology & carcinogenesis business Perforator Flap |
| Zdroj: | Journal of reconstructive microsurgery, 37(2), 111-118. Thieme Medical Publishers |
| ISSN: | 0743-684X |
| Popis: | Background Numerous new and novel imaging techniques for preoperative perforator selection in deep inferior epigastric artery perforator (DIEP) flap planning have been introduced. To what extent, these have been adopted into or replaced routine practice has hitherto remained unknown. The purpose of this study was to identify the currently preferred technique by reconstructive surgeons, the criteria that they regard as most relevant and what impact these have on the preoperative decision-making. Methods An online survey consisting of 25 questions was sent to members of the Benelux Societies for Plastic Surgery. Information regarding experience and preferred imaging modality was requested. Specific questions addressed the utilization of computed tomography angiography (CTA) and factors that could inform preoperative perforator selection. Results were anonymously collected, managed using REDCap, and analyzed using Chi-square statistic. Results Seventy-nine principal surgeons could be included. A variation in surgeon experience was observed. On CTA, the preferred imaging modality, large-caliber vessels, the location of the perforator in the flap, and its intramuscular course were considered the most significant criteria. Surgeons doing more than 20 DIEP flaps per year are less concerned about the distance of the perforator from the umbilicus (p = 0.003) but more likely to choose a medial perforator (p = 0.011). No statistical difference was found in surgeons' experience between those who would choose and use one specific (medial or lateral) perforator when they are analogous on CTA, and those who would delay the decision until both perforators have been exposed. Conclusion Advantages and disadvantages of the current practice of preoperative perforator selection by surgeons who are primarily responsible for harvesting a DIEP flap have been clearly identified. Indications are that these could be widely representative in which case, the quest for a protocol or modality that maximizes the benefit and minimizes harm in preoperative perforator mapping is urgently required. |
| Databáze: | OpenAIRE |
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