A standardized preoperative imaging regime reduces major complications in abdominal free flaps breast reconstruction– a retrospective cohort study

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Background The deep inferior epigastric perforator (DIEP) is considered the gold standard for free flap breast reconstruction. The use of multiple preoperative imaging modalities such as color Doppler ultrasonography (CDU), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) is increasingly used in surgical planning and preparation. In this study, we investigated the effect of standardized preoperative imaging on abdominal free flap breast reconstruction. Method In this retrospective cohort study the data of the 173 patients who had undergone unilateral abdominal free flap breast reconstruction at the Department of Plastic Surgery at Odense University Hospital from January 2011 - December 2020, were analyzed. Group 1 primarily used sound Doppler and clinical visualization of perforators during surgery. Group 2 had a standardized preoperative planning using CTA, in combination with CDU and sound Doppler. Results One hundred and seventy-three patients were operated. Group 1 included 134 patients and group 2 included 39 patients. In group 1 the patients were reconstructed with 78 (58%) DIEP flaps, 49 (37%) muscle sparing TRAM flaps, and 7 (5%) TRAM flaps. In group 2 all patients were reconstructed with a DIEP flap. Total Flap loss, Group 1: 10/134 (7.46%), group 2: 0/39 (0%), p = 0.1192. Major complications: Group 1: 34/134 (25%), group 2: 3/39 (8%), p = 0.031. Conclusions Optimized preoperative planning using combined CTA, CDU and sound Doppler optimizes the outcomes of abdominal free flap breast reconstruction and enables safer reconstruction with DIEP flaps. Level of evidence Level III, therapeutic study.