Simple Evaluation Method of Deep Inferior Epigastric Artery and its Perforators Using a Three-Dimensional Computer...

This study aimed to evaluate the accuracy and simplicity of a preoperative vascular assessment method with Viewtify^Ⓡ for perforator flap elevation.

To evaluate the accuracy and simplicity of this new method, we compared it with an existing reliable method based on the same contrast-enhanced computed tomography (CT) images. The evaluation included the deviation of the deep inferior epigastric artery (DIEA) course and the position of the perforators, as well as the time required for evaluation. CT images were acquired from 20 female patients who underwent DIEA perforator flap reconstruction. A third-year plastic surgery resident, new to flaps and the software, was the candidate for this new method and hand-drew a schematic diagram from three-dimensional computer graphics (3DCG) images reconstructed with Viewtify^Ⓡ. After receiving only short instructions on how to operate the software, she began the evaluations. The comparison was made with reference images that had been created by a board-certified surgeon using a reliable method from the same CT images.

The average age and body mass index (BMI) of patients were 48.1 ± 7.5 years and 24.2 ± 3.3 kg/m², respectively. Deviations in the DIEA pathway were within 7.4 ± 3.2 mm, and perforator positions matched the reference images. Evaluation times decreased significantly, stabilizing below 10 min in 5 patients. The average evaluation time across all patients was approximately 8 minutes.

Viewtify^Ⓡ enables accurate and efficient preoperative vascular assessment, even for inexperienced surgeons, demonstrating a rapid learning curve. This method may offer an alternative approach for the surgical planning of perforator flap elevation.