Best choice of perforator vessel in autologous breast reconstruction: Virtual reality navigation vs radiologist...

Computed tomographic angiography (CTA) is being considered as the current "gold standard" for the preoperative planning of DIEP flaps. The aim of the study was to demonstrate the concordance between the preoperative choice of the best perforator vessel by the radiologist using CTA and the surgeon using the VirSSPA software.

A prospective and comparative study was conducted in patients needing immediate or secondary breast reconstruction. The radiologist (CTA) and the surgeon (VirSSPA software) analyzed the number of perforators, their course, their location, and then determined the best perforator of the DIEP flap.

Best perforator concordance was 33% between the radiologist and the surgeon. The perforator used for reconstruction was chosen by the radiologist in 16 cases (53%) and in 10 cases (33%) by the surgeon. In only nine cases was the same perforator chosen by both of them. Distances of the best perforator from the umbilicus measured by VirSSPA showed an error margin varying from 1-47 mm from the real distances measured by CTA. The Pearson product-moment correlation coefficient was found to be 0.0235 (p = 0.94), reflecting a non-linear relationship.

CTA with a well-trained radiologists continues to be, for us, the gold standard for the preoperative choice of the best perforator.