Planning and optimising DIEP flaps with virtual surgery: the Navarra experience
Warren Matthew Rozen (a), Emilio Garcia-Tutor (b), Alberto Alonso-Burgos (c), Rafael Acosta (d), Filip Stillaert (e), Jose Luis Zubieta (c), Mustapha Hamdi (e), Iain S. Whitaker (f), Mark W. Ashton (a)
(a) Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Grattan Street, Parkville 3050, Victoria, Australia
(b) Department of Plastic Surgery, Clinica Universitaria, Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
(c) Department of Radiology, Clinica Universitaria, Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
(d) Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala, Sweden
(e) Department of Plastic and Reconstructive Surgery, Gent University Hospital, Gent, Belgium
(f) Department of Plastic, Reconstructive and Burns Surgery, The Welsh National Plastic Surgery Unit, The Morriston Hospital, Swansea, UK
Methods to improve operative outcomes in deep inferior epigastric artery perforator flap surgery have previously focussed on operative technique and postoperative-course modification. Recently, preoperative imaging has become capable of mapping the entire course of perforating vessels, including those vessels as small as 0.3mm, enabling 'virtual surgery' to be performed preoperatively.
This has been shown to facilitate faster and safer surgery. The recent 'Navarra' meeting classified current imaging modalities and discussed the current status of imaging modalities for this role. This article discusses the current expectations and optimal techniques for achieving these outcomes through the available imaging modalities: Doppler ultrasound, colour Doppler (duplex) ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Features of imaging that are of importance to the surgeon are explored, and a consensus statement has been developed that describes exactly what the current imaging modalities should aim to deliver to the surgeon prior to operating, as well as the benefits and pitfalls of each of these modalities.
The techniques described herein permit the radiologist and the surgeon to perform virtual surgery together, preoperatively.
CITATION J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):289-97