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An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
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Planning and optimising DIEP flaps with virtual surgery: the Navarra experience
Warren Matthew Rozen1, Emilio Garcia-Tutor, Alberto Alonso-Burgos
1Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Grattan Street, Parkville 3050, Victoria, Australia. warrenrozen@hotmail.com
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|December 2, 2008
Summary
Preoperative imaging, including Doppler ultrasound and CT angiography, enables detailed mapping of small blood vessels for deep inferior epigastric artery perforator flap surgery. This facilitates
Area of Science:
- Microsurgery
- Radiology
- Plastic Surgery
Background:
- Deep inferior epigastric artery (DIEP) perforator flap surgery outcomes traditionally improved via operative technique and postoperative care.
- Preoperative imaging advancements now allow detailed mapping of perforator vessels (down to 0.3 mm).
- This enables 'virtual surgery' planning, potentially enhancing surgical speed and safety.
Purpose of the Study:
- To discuss current expectations and optimal techniques for preoperative imaging in DIEP flap surgery.
- To explore imaging features crucial for surgical planning.
- To present a consensus on the role and requirements of imaging modalities.
Main Methods:
- Review and discussion of available imaging modalities: Doppler ultrasound, color Doppler (duplex) ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA).
- Exploration of imaging features critical for surgeon utility.
- Development of a consensus statement on imaging goals and modality performance.
Main Results:
- Detailed mapping of perforator vessels, even small ones (0.3 mm), is achievable with current imaging technologies.
- Virtual surgery planning through preoperative imaging facilitates faster and safer surgical procedures.
- The article outlines the benefits and pitfalls of each imaging modality (Doppler, CTA, MRA).
Conclusions:
- Preoperative imaging, particularly CTA and MRA, is vital for optimizing DIEP flap surgery.
- Collaborative 'virtual surgery' between radiologists and surgeons enhances operative planning.
- Standardized imaging protocols are needed to maximize the benefits of preoperative vessel mapping.
