Ruolo dell’AngioTC nel miglioramento della pianificazione pre-operatoria del lembo DIEAP

Abdominal donor site flaps and in particular DIEAP (Deep Inferior Epigastric Perforator), are becoming the gold standard for autologous breast reconstruction. The use of this flap has been limited by concerns over vascular anatomy of the abdominal wall. An accurate preoperative evaluation of the location, size and course of perforator vessels is essential. For this purpose, Computed Tomographic Angiography (CTA) has become increasingly adopted, as it has been shown to improve operative outcomes and decrease operating times. We present our experience of using CTA of the abdomen as part of our standard preoperative assessment of the patients who will undergo autologous breast reconstruction with DIEAP flap. From January 2007 to July 2009, 37 patients underwent immediate or delayed breast reconstruction with DIEAP flap, of these 35 were studied preoperatively with CTA. Moreover, in the first stage of the study we compared CTA with other techniques, such as unidirectional Doppler probe and twodimensional Color Doppler. CTA has been shown to be the most accurate modality for perforator mapping, with high sensitivity, high specificity and high correlation with intraoperative findings. Our experience with CTA has been highly beneficial. CTA may guide operative technique and improve perforator selection in every cases, decreasing surgical times and complication rate. Moreover, in difficult cases such as comorbidities or previous abdominal surgery, it can guide the selection of the most appropriate operation.