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Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

   The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction.

Methods

   Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes (\(\hbox {cm}^{3}\)) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed.

Results

   40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, \(p < 0.001\)), allowing a prediction accuracy within 0.29 \(\pm \) 3.0 % (range: from \(-\)8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes (\(p < 0.001\)), leading to an average of 21 % of the remnant flap tissue potentially being discarded.

Conclusions

   CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry.

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Acknowledgments

The authors would like to thank Prof. Dr. A. Haase, Director of the Institute of Medical Engineering at the Technische Universität München (IMETUM), Germany, for his cooperation and infrastructural support. Funding for the study was received by the Federal Ministry of Economics and Technology, Germany (BMWi-Grant No.: KF2061601KJ1).

Conflict of interest

All authors will disclose any financial and personal relationships with other people or organizations that inappropriately influence (bias) their work. None of the authors are shareholders of one of the named companies whose drugs, medical devices, hardware and software were used in the study, and no author has any other financial interests with the named companies.

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Authors and Affiliations

  1. Research Group—Computer Aided Plastic Surgery (CAPS), Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , Munich, Germany

    Maximilian Eder, Stefan Raith, Jalil Jalali, Daniel Müller, Yves Harder, Nikolaos A. Papadopulos, Hans-Günther Machens & Laszlo Kovacs

  2. Institute of Medical Engineering at the Technische Universität München (IMETUM), Boltzmannstr. 11, 85748 , Garching, Germany

    Jalil Jalali

  3. Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 , Munich, Germany

    Martin Dobritz

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  1. Maximilian Eder
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  2. Stefan Raith
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  3. Jalil Jalali
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  4. Daniel Müller
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  7. Nikolaos A. Papadopulos
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  8. Hans-Günther Machens
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  9. Laszlo Kovacs
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Correspondence to Maximilian Eder.

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Eder, M., Raith, S., Jalali, J. et al. Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging. Int J CARS 9, 541–549 (2014). https://doi.org/10.1007/s11548-013-0941-4

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  • DOI: https://doi.org/10.1007/s11548-013-0941-4

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