MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Juan A. Clavero1,
Jaume Masia2,
Jose Larrañaga2,
Josep M. Monill1,
Gemma Pons2,
Sahyly Siurana1 and
Xavier Alomar1
1 Department of Radiology, Creu-Blanca, C/Corcega 345, 08037 Barcelona,
Spain.
2 Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau,
Universitat Autonoma de Barcelona, Barcelona, Spain.
View larger version (62K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A —Blood supply of normal cutaneous tissue of raised perforator
flap. F = fascia, M = muscle, P = perforator vessel, S = subcutaneous fat.
Drawing shows normal anatomy of perforator artery piercing muscle and fascia
to provide blood supply in cutaneous tissue.
|
|
View larger version (39K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1B —Blood supply of normal cutaneous tissue of raised perforator
flap. F = fascia, M = muscle, P = perforator vessel, S = subcutaneous fat.
Drawing shows perforator flap after muscular dissection of vascular
pedicle.
|
|
View larger version (65K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2B —Deep inferior epigastric perforator (DIEP) flap for breast
reconstruction. Drawing shows immediate postoperative result after
transferring abdominal tissue to chest wall with internal mammary
microvascular anastomosis.
|
|
View larger version (107K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3A —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Three axial MDCT images show deep inferior epigastric artery
course. Most caudal image shows origin of deep inferior epigastric artery in
external iliac artery (arrows).
|
|
View larger version (101K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3B —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Three axial MDCT images show deep inferior epigastric artery
course. More cephalad axial image shows course of deep inferior epigastric
artery behind rectus abdominis muscles (arrows).
|
|
View larger version (101K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3C —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Three axial MDCT images show deep inferior epigastric artery
course. Most cephalad image shows intramuscular course of deep inferior
epigastric artery (arrows). Note perforator vessel
(arrowheads).
|
|
View larger version (134K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4A —52-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Axial (A) and sagittal (B) reformatted MDCT
images show perforator branch (arrow) of left deep inferior
epigastric artery emerging from rectus sheath.
|
|
View larger version (141K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4B —52-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Axial (A) and sagittal (B) reformatted MDCT
images show perforator branch (arrow) of left deep inferior
epigastric artery emerging from rectus sheath.
|
|
View larger version (139K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5 —59-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. MDCT image shows perforator vessel emerging through tendinous
band (arrows).
|
|
View larger version (100K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6A —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Location of largest perforator vessels is shown on axial MDCT
image (A) and 3D superficial volume-rendered image (B). Arrow in
A indicates cutaneous location of emerging fascial point of largest
perforator vessel (black arrow in B). White arrow in B
indicates another perforator vessel not seen in A.
|
|
View larger version (117K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6B —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Location of largest perforator vessels is shown on axial MDCT
image (A) and 3D superficial volume-rendered image (B). Arrow in
A indicates cutaneous location of emerging fascial point of largest
perforator vessel (black arrow in B). White arrow in B
indicates another perforator vessel not seen in A.
|
|
View larger version (74K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6C —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Results of A and B are reflected in custom-made
form.
|
|
View larger version (100K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6D —48-year-old woman undergoing MDCT for preoperative planning
of deep inferior epigastric perforator (DIEP) flap surgery for breast
reconstruction. Photograph shows data obtained from MDCT marked on patient's
abdominal skin to facilitate intraoperative location.
|
|
View larger version (110K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 7 —52-year-old woman with deep inferior epigastric perforator
(DIEP) flap preoperative planning for breast reconstruction. Volume-rendered
axial MDCT image shows paramuscular perforator vessel piercing fascia at
periumbilical level (arrow). Note left lumbar perforator vessel
(arrowheads).
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2008 by the American Roentgen Ray Society.
