Randomized Control Trial of the Utility of Preoperative CT-Angiography in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

BACKGROUND: CT-angiogram has become the preferred method for the planning of abdominal-based microsurgical breast reconstruction to gather information about location, number, caliber, and trajectory of the abdominal perforators and to decrease overall flap dissection and operating room time. However, the high-level evidence to support its utility has been limited to nonrandomized retrospective and prospective studies. METHODS: Patients undergoing deep inferior epigastric artery perforator flap breast reconstruction were prospectively randomized to preoperative CT-angiogram and no imaging groups. Patient demographics, operative times, selected row, and number of perforators for flap harvest, agreement in perforator selection between radiologist and surgeon and clinical outcomes data were collected. Two-way analysis of variance, Fischer’s exact, and Student’s t tests were used for statistical analysis. RESULTS: Overall, 37 patients with 63 flaps were included in this study. Seventeen patients had CT scan before surgery. Mean age was 50.5 ± 9.64 years. Flap dissection time was significantly shorter in the CT group (150.82 ± 17,866 versus 184.74 ± 25.125 minutes; P < 0.001). Although overall OR time was also shorter in the CT group, this only reached to a statistical significance in bilateral surgeries (575.91 ± 70.10 versus 641.87 ± 79.55; P = 0.038). Hemiabdomen side, selected DIEA row, and number of dissected perforators did not affect the overall dissection time. Complication rates were similar between the 2 groups. CONCLUSION: This prospective, randomized study demonstrates that preoperative CT-angiogram analysis of perforators decreases flap harvest and overall OR time with equivalent postoperative outcomes.