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Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction

BACKGROUND: Autologous breast reconstruction is an integral part in the treatment of breast cancer. While computed tomography angiography (CTA) is an established preoperative diagnostic tool for microsurgeons, no study has so far evaluated and compared five different imaging methods and their value...

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Autores principales: Schrögendorfer, K. F., Nickl, S., Keck, M., Lumenta, D. B., Loewe, C., Gschwandtner, M., Haslik, W., Nedomansky, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660891/
https://www.ncbi.nlm.nih.gov/pubmed/29142584
http://dx.doi.org/10.1007/s10353-016-0449-6
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author Schrögendorfer, K. F.
Nickl, S.
Keck, M.
Lumenta, D. B.
Loewe, C.
Gschwandtner, M.
Haslik, W.
Nedomansky, J.
author_facet Schrögendorfer, K. F.
Nickl, S.
Keck, M.
Lumenta, D. B.
Loewe, C.
Gschwandtner, M.
Haslik, W.
Nedomansky, J.
author_sort Schrögendorfer, K. F.
collection PubMed
description BACKGROUND: Autologous breast reconstruction is an integral part in the treatment of breast cancer. While computed tomography angiography (CTA) is an established preoperative diagnostic tool for microsurgeons, no study has so far evaluated and compared five different imaging methods and their value for the reconstructive team. In order to determine the feasibility of each of the tools for routine or specialized diagnostic application, the methods’ efficiency and informative value were analyzed. METHODS: We retrospectively analyzed imaging data of 41 patients used for perforator location and assessment for regional perfusion and vessel patency in patients undergoing autologous breast reconstruction with deep inferior epigastric perforator flap (DIEP), transverse rectus abdominis muscle flap (TRAM), or transverse myocutaneous gracilis flap (TMG). Five different imaging techniques were used: hand held Doppler (HHD), CT angiography (CTA), macroscopic indocyanine green (ICG) video angiography, microscope-integrated ICG video angiography, and laser Doppler imaging (LDI). RESULTS: CTA proved to be the best tool for preoperative determination of the highly variable anatomy of the abdominal region, whereas HHD showed the same information on perforator localization with some false-positive results. Intraoperative HHD was an excellent tool for dissection and vessel patency judgment. Microscope-integrated ICG was an excellent tool to document the patency of microanastomoses. In our series, macroscopic perfusion measurement with ICG or LDI was only justified in special situations, where information on perfusion of abdominal or mastectomy flaps was required. LDI did not add any additional information. CONCLUSION: Preoperative assessment should be performed by CTA with verification of the perforator location by HHD. Intraoperative HHD and microscope-integrated ICG contribute most toward the evaluation of vessel patency. ICG and LDI should only be used for special indications.
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spelling pubmed-56608912017-11-13 Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction Schrögendorfer, K. F. Nickl, S. Keck, M. Lumenta, D. B. Loewe, C. Gschwandtner, M. Haslik, W. Nedomansky, J. Eur Surg Original Article BACKGROUND: Autologous breast reconstruction is an integral part in the treatment of breast cancer. While computed tomography angiography (CTA) is an established preoperative diagnostic tool for microsurgeons, no study has so far evaluated and compared five different imaging methods and their value for the reconstructive team. In order to determine the feasibility of each of the tools for routine or specialized diagnostic application, the methods’ efficiency and informative value were analyzed. METHODS: We retrospectively analyzed imaging data of 41 patients used for perforator location and assessment for regional perfusion and vessel patency in patients undergoing autologous breast reconstruction with deep inferior epigastric perforator flap (DIEP), transverse rectus abdominis muscle flap (TRAM), or transverse myocutaneous gracilis flap (TMG). Five different imaging techniques were used: hand held Doppler (HHD), CT angiography (CTA), macroscopic indocyanine green (ICG) video angiography, microscope-integrated ICG video angiography, and laser Doppler imaging (LDI). RESULTS: CTA proved to be the best tool for preoperative determination of the highly variable anatomy of the abdominal region, whereas HHD showed the same information on perforator localization with some false-positive results. Intraoperative HHD was an excellent tool for dissection and vessel patency judgment. Microscope-integrated ICG was an excellent tool to document the patency of microanastomoses. In our series, macroscopic perfusion measurement with ICG or LDI was only justified in special situations, where information on perfusion of abdominal or mastectomy flaps was required. LDI did not add any additional information. CONCLUSION: Preoperative assessment should be performed by CTA with verification of the perforator location by HHD. Intraoperative HHD and microscope-integrated ICG contribute most toward the evaluation of vessel patency. ICG and LDI should only be used for special indications. Springer Vienna 2016-10-19 2016 /pmc/articles/PMC5660891/ /pubmed/29142584 http://dx.doi.org/10.1007/s10353-016-0449-6 Text en © The Author(s) 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Schrögendorfer, K. F.
Nickl, S.
Keck, M.
Lumenta, D. B.
Loewe, C.
Gschwandtner, M.
Haslik, W.
Nedomansky, J.
Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title_full Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title_fullStr Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title_full_unstemmed Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title_short Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
title_sort viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660891/
https://www.ncbi.nlm.nih.gov/pubmed/29142584
http://dx.doi.org/10.1007/s10353-016-0449-6
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