Computed Tomographic Angiography with VirSSPA Three-Dimensional Software for Perforator Navigation Improves Perioperative Outcomes in DIEP Flap Breast Reconstruction

BACKGROUND: Vascular anatomy of the abdominal wall varies greatly, especially in the case of the perforator branches of the deep inferior epigastric artery. Preoperative three-dimensional reconstructions with VirSSPA software have been used in the authors' center since the year 2007 for the planning of perforator flaps in breast reconstruction. The main objectives were to reduce surgery time and the number of complications. METHODS: A comparative study was conducted in 70 patients subjected to delayed breast reconstruction based on unilateral deep inferior epigastric perforator (DIEP) flaps. Half of the patient group underwent preoperative imaging with computed tomographic angiography-guided VirSSPA reconstruction, whereas the other half was subjected to preoperative Doppler ultrasound for perforator mapping. Operation time ranges, lengths of stay, and operative complications were assessed. RESULTS: The use of VirSSPA preoperative planning correlated with operative times reduced by a mean of 2 hours 8 minutes. In addition, a statistically significant reduction (>45 percent) in the incidence of any flap-related complications was observed in patients undergoing preoperative computed tomographic angiography-guided VirSSPA reconstruction and a decrease above 50 percent in overall donor-site morbidity. The use of computed tomographic angiography-guided VirSSPA three-dimensional reconstruction was found to be a protective factor against developing any kind of complication after DIEP flap surgery (odds ratio, 0.03; 95 percent confidence interval, 0.006 to 0.15). CONCLUSIONS: Computed tomographic angiography-guided VirSSPA three-dimensional reconstruction in the assessment of perforator flaps was proved to be safe and reliable. The main benefits of this technique were the reduction of surgical time and reduction of the number of complications.