PET/CT for perforator identification in deep inferior epigastric perforator flap harvest

CT angiography (CTA) is used for preoperative localization in deep inferior epigastric perforator (DIEP) flaps, but is an additional costly study that involves contrast and radiation exposure. Many patients with head and neck cancer already undergo PET/CT. We investigated if PET/CT could be used to preoperatively localize perforators and if this corresponded with the intraoperative location.

This was a prospective cohort study at an academic tertiary care center between 2017 and 2022. Participants were adults with head and neck cancer who had undergone PET/CT and were scheduled to undergo reconstruction with DIEP flaps. The mean difference between the preoperative and intraoperative horizontal and vertical distance of perforators from the umbilicus was determined.

Preoperative and intraoperative measurements were obtained from 42 perforators (30 patients). The mean difference between preoperative and intraoperative measurements was not statistically significant for HDU (-0.05 with 95 % CI [-0.11, 0.01], p = 0.13) or VDU (-0.02 with 95 % CI [-0.06, 0.03] p = 0.41). Bland-Altman analysis demonstrated limits of agreement of -0.42 (95 % CI [-0.52, -0.31]) to 0.33 (95 % CI [0.23, 0.43]) for HDU and -0.31 (95 % CI [-0.39, -0.23]) to 0.27 (95 % CI [0.19, 0.35]) for VDU. This was within our chosen limit of agreement of 1 cm.

Preoperative identification of DIEP perforators on PET/CT can be used to locate perforators intraoperatively. Utilizing this method facilitates efficient flap harvesting and does not require an additional imaging study since many patients undergo PET/CT.