Floor plan - 2013 Annual Meeting - American Association for Hand ...

Imaging Techniques in Preoperative Planning of the Abdominal Perforator Flaps: Our
Experience Using the MRI
Institution where the work was prepared: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Jaume Masia, MD, PhD1; Jm Monill1; Ja Clavero2; G. Pons1; J. Larrañaga1; L. Vives1; (1)Sant Pau University Hospital
(Universitat Autonoma de Barcelona), (2)Clinica Creu Blanca
INTRODUCTION:
The key to predict the viability for any muscle perforator flap is an adequate circulation of the chosen perforator. Therefore, a reliable
method for the precise identification of the dominant perforator with regard to its position, course and calibre would be extremely valuable.
During the last 4 years we have been using the multidetector-row CT (MDCT) for the preoperative planning in DIEP flaps with an
excellent results, it helps us in reducing the operating time and the complication rates. Unfortunately, even being less than a conventional
abdominal CT scan, the main drawback for the patient still is the radiation. .
METHOD:
Between January 2006 and January 2007 we performed 86 DIEAP flaps for breast reconstruction in 76 female patients. The mean age
was 46.7 (range 24-70 years). An preoperative multi-dectector row CT and a MRI were done in the first 36 cases, comparing the results
with the preoperative doppler sonography findings and the intraoperative clinical findings. After the comparative study we have been
using only the MRI as the preoperative planning method.
RESULTS:
Comparing the MDCT and the MRI with the intraoperative findings, no false positive and no false negative results were found. We can
get the same information with both techniques but the MRI gives better 3D reconstruction images of the perforator branching inside
the flap. Therefore MRI seems to have the same advantages of the MDCT but no radiation.
CONCLUSION:
In conclusion we find that the MRI is a very useful tool which provides a reliable method for studying the inferior epigastric artery perforators
of the lower abdomen. MDCT allows an anatomic study of the donor area, very ease of interpretation not only by the radiologist
even by the plastic surgeon. It gives us the possibility to do a virtual anatomy dissection of the patient by the computer because
the pictures obtained are 3 dimensional anatomy reconstructions. Therefore it help us in reducing the operating time and the complication
rates.
Innervation Improves Patient-Rated Quality of Life in Free TRAM Breast Reconstruction
Institution where the work was prepared: University of Western Ontario, London, ON, Canada
Sharon Kim, MD, FRCSC1; Claire LF Temple, MD, FRCSC2; Douglas C. Ross, MD, FRCSC3; Raymond Tse, BSc, MD4;
Margo Bettger-Hahn, BScN, MScN3; Bing Siang Gan, MD, PhD, FRCSC4; Joy MacDermid, PhD, PT4; (1)Mayo Clinic,
(2)University of Western Ontario, (3)St. Joseph's Health Centre, (4)Hand and Upper Limb Centre
BACKGROUND:
Restoring sensory innervation has proven to be a useful adjunct in free flap head and neck reconstruction but as yet, has not been shown
to improve outcomes of breast reconstruction. Our previous study demonstrated objectively improved sensation in a group of innervated
transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction patients relative to non-innervated flaps. The purpose
of this study is to compare patient-rated outcomes of free TRAM breast reconstruction in innervated versus non-innervated flaps.
METHODS:
Twenty-six women were prospectively randomized to receive either an innervated or a non-innervated free TRAM breast reconstruction.
For innervated flaps, the T10 intercostal nerve was harvested with the TRAM flap and neurotized to the T4 sensory nerve at the
recipient site. Three validated outcome tools were administered pre- and post-surgery. These included the SF-36 Health Survey, the
Breast Cancer Therapy Quality of Life Instrument and the Body Image after Breast Cancer Questionnaire. Results of these outcomes
were correlated with previously reported objective sensibility outcomes.
RESULTS:
Demographic analysis revealed no significant differences in patient age, height, smoking, radiation therapy and nipple-areola reconstruction
between randomized patient groups. Time to average follow-up was 28 months. There was a statistically significant improvement
in all three measures (SF-36, BIBCQ and FACT-B) in patients who were randomized to receiving innervated free TRAM flaps compared
to those receiving non-innervated flaps.
CONCLUSIONS:
This study demonstrates that innervation of free TRAM flaps used for breast reconstruction not only improves sensibility but also has a
positive effect upon patient-rated quality of life.
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