Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction

Corrine Wong, Michel Saint-Cyr, Gary Arbique, Stephen Becker, Spencer Brown, Simon Myers, Rod J. Rohrich

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

BACKGROUND: The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps. METHODS: A total of 11 lower abdominal flaps were obtained from nine cadavers and two abdominoplasty procedures. The authors simulated the perfusion of seven pedicled TRAMs, eight full TRAMs, eight muscle-sparing TRAMs, 14 DIEPs, and six superficial inferior epigastric artery flaps. For each simulated flap, the named artery/perforator was injected with Omnipaque contrast using a Harvard precision pump at 0.5 ml/minute, and the flap was subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Scans were repeated at 0.125-ml increments (every 15 seconds) for the first 1 ml, then at 0.5-ml increments (every 60 seconds) for the next 2 to 3 ml, thus giving progressive computed tomographic images over time. Images were viewed using both General Electrics and TeraRecon systems, allowing analysis of branching patterns and perfusion flow as well as measurements of vascular territory. CONCLUSIONS: This study shows that there are definitive differences in vascular territory based on flap type. The sequences of images also allow us to reappraise the classic Hartrampf zones of perfusion.

Original languageEnglish (US)
Pages (from-to)18-27
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume124
Issue number1
DOIs
StatePublished - Jul 2009

Fingerprint

Four-Dimensional Computed Tomography
Mammaplasty
Perfusion
Blood Vessels
Abdominoplasty
Epigastric Arteries
Perforator Flap
Iohexol
Muscles
Rectus Abdominis
Myocutaneous Flap
Free Tissue Flaps
Cadaver
Angiography
Arteries

ASJC Scopus subject areas

  • Surgery

Cite this

Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction. / Wong, Corrine; Saint-Cyr, Michel; Arbique, Gary; Becker, Stephen; Brown, Spencer; Myers, Simon; Rohrich, Rod J.

In: Plastic and Reconstructive Surgery, Vol. 124, No. 1, 07.2009, p. 18-27.

Research output: Contribution to journalArticle

Wong, Corrine ; Saint-Cyr, Michel ; Arbique, Gary ; Becker, Stephen ; Brown, Spencer ; Myers, Simon ; Rohrich, Rod J. / Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction. In: Plastic and Reconstructive Surgery. 2009 ; Vol. 124, No. 1. pp. 18-27.
@article{524180a02f6942279205992fd5699c3c,
title = "Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction",
abstract = "BACKGROUND: The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps. METHODS: A total of 11 lower abdominal flaps were obtained from nine cadavers and two abdominoplasty procedures. The authors simulated the perfusion of seven pedicled TRAMs, eight full TRAMs, eight muscle-sparing TRAMs, 14 DIEPs, and six superficial inferior epigastric artery flaps. For each simulated flap, the named artery/perforator was injected with Omnipaque contrast using a Harvard precision pump at 0.5 ml/minute, and the flap was subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Scans were repeated at 0.125-ml increments (every 15 seconds) for the first 1 ml, then at 0.5-ml increments (every 60 seconds) for the next 2 to 3 ml, thus giving progressive computed tomographic images over time. Images were viewed using both General Electrics and TeraRecon systems, allowing analysis of branching patterns and perfusion flow as well as measurements of vascular territory. CONCLUSIONS: This study shows that there are definitive differences in vascular territory based on flap type. The sequences of images also allow us to reappraise the classic Hartrampf zones of perfusion.",
author = "Corrine Wong and Michel Saint-Cyr and Gary Arbique and Stephen Becker and Spencer Brown and Simon Myers and Rohrich, {Rod J.}",
year = "2009",
month = "7",
doi = "10.1097/PRS.0b013e3181aa0db8",
language = "English (US)",
volume = "124",
pages = "18--27",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction

AU - Wong, Corrine

AU - Saint-Cyr, Michel

AU - Arbique, Gary

AU - Becker, Stephen

AU - Brown, Spencer

AU - Myers, Simon

AU - Rohrich, Rod J.

PY - 2009/7

Y1 - 2009/7

N2 - BACKGROUND: The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps. METHODS: A total of 11 lower abdominal flaps were obtained from nine cadavers and two abdominoplasty procedures. The authors simulated the perfusion of seven pedicled TRAMs, eight full TRAMs, eight muscle-sparing TRAMs, 14 DIEPs, and six superficial inferior epigastric artery flaps. For each simulated flap, the named artery/perforator was injected with Omnipaque contrast using a Harvard precision pump at 0.5 ml/minute, and the flap was subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Scans were repeated at 0.125-ml increments (every 15 seconds) for the first 1 ml, then at 0.5-ml increments (every 60 seconds) for the next 2 to 3 ml, thus giving progressive computed tomographic images over time. Images were viewed using both General Electrics and TeraRecon systems, allowing analysis of branching patterns and perfusion flow as well as measurements of vascular territory. CONCLUSIONS: This study shows that there are definitive differences in vascular territory based on flap type. The sequences of images also allow us to reappraise the classic Hartrampf zones of perfusion.

AB - BACKGROUND: The innovative technique of three- and four-dimensional computed tomographic angiography allows us to analyze the areas of perfusion in commonly used free abdominal flaps in breast reconstruction, such as pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps, full TRAMs, muscle-sparing TRAMs, and deep inferior epigastric perforator (DIEP) flaps. The authors compared the vascular territories in these flaps. METHODS: A total of 11 lower abdominal flaps were obtained from nine cadavers and two abdominoplasty procedures. The authors simulated the perfusion of seven pedicled TRAMs, eight full TRAMs, eight muscle-sparing TRAMs, 14 DIEPs, and six superficial inferior epigastric artery flaps. For each simulated flap, the named artery/perforator was injected with Omnipaque contrast using a Harvard precision pump at 0.5 ml/minute, and the flap was subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Scans were repeated at 0.125-ml increments (every 15 seconds) for the first 1 ml, then at 0.5-ml increments (every 60 seconds) for the next 2 to 3 ml, thus giving progressive computed tomographic images over time. Images were viewed using both General Electrics and TeraRecon systems, allowing analysis of branching patterns and perfusion flow as well as measurements of vascular territory. CONCLUSIONS: This study shows that there are definitive differences in vascular territory based on flap type. The sequences of images also allow us to reappraise the classic Hartrampf zones of perfusion.

UR - http://www.scopus.com/inward/record.url?scp=68249086827&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68249086827&partnerID=8YFLogxK

U2 - 10.1097/PRS.0b013e3181aa0db8

DO - 10.1097/PRS.0b013e3181aa0db8

M3 - Article

C2 - 19568040

AN - SCOPUS:68249086827

VL - 124

SP - 18

EP - 27

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 1

ER -