Evaluation of three-dimensional computed tomography processing for deep inferior epigastric perforator flap breast reconstruction

One in eight women will develop invasive breast cancer during her life. Many of these women will choose to remove a part of the breast or have a mastectomy (1). The deep inferior epigastric perforator (DIEP) flap procedure is quickly becoming a popular breast reconstructive option for women who will or have undergone mastectomies. The DIEP flap consists of autologous tissue from the abdominal area. Skin, fat and vessels are harvested while the underlying rectus abdominis muscles are left in place (2). As a result, the risk of abdominal weakness and hernias is reduced (3). During the DIEP procedure, the surgeons must ensure that the tissue they harvest is well-vascularized to prevent tissue necrosis. The DIEP flap is supplied by the deep inferior epigastric artery, which originates from the external iliac artery slightly rostral to the inguinal ligament, and its branches perforate through the rectus abdominal muscles (4). While some surgeons may choose to find the perforator arteries intraoperatively, there are many advantages in locating the arteries pre-operatively. By mapping the locations of the arteries on a grid, using the umbilicus as the origin, the surgeons have a better idea of what they will see as they lift the skin flap. Additionally, measuring the caliber of perforator arteries pre-operatively allows the surgeon to decide which region of tissue to use based on vascularization (5). Current methods of imaging the abdomen include Doppler ultrasound and computed tomography (CT) (5). The goal of the present project was to produce a map of the perforator arteries using either two-dimensional (2D) or three-dimensional (3D) CT, and comparing the two methods to determine which is faster. Additionally, we will determine whether there is any added benefit in producing a 3D image of the abdominal anatomy.