Abstract Background Autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flap and transversus rectus abdominis myocutaneous (TRAM) flap require precise preoperative planning. Our aim was to perform morphometric analysis of deep inferior epigastric artery (DIEA) and its perforators through CT-Angiography (CTA) during preoperative planning. Methods A prospective single center, single surgeon study of CTA of patients after mastectomy, undergoing DIEP or TRAM flap breast reconstruction from 2022 till 2024. Patients CTA images were analyzed for DIEA, DIEP and abdominal wall anatomy. Findings were correlated with rate of postoperative partial flap necrosis and total flap loss. Statistical analysis was performed by unpaired t test (two-tailed), Fisher´s exact test and Pearson correlation coefficient. Results CTA imaging was analyzed in 16 patients (100 perforators). Average number of lateral and medial row perforators per side was 1.39 ± 0.5 and 1.78 ± 0.8 ( p < 0.05), respectively. The mean diameter of dominant perforators was 0.85 ± 0.16 mm. The vertical and horizontal distance of dominant perforators from the umbilicus was on average 26.42 ± 18.2 mm and 35.4 ± 18.31 mm, respectively. Larger horizontal distance from the umbilicus correlated with lower rate of partial flap necrosis and total flap loss ( p < 0.05). Conclusion We found significant difference in number of medial and lateral perforators of DIEA. Horizontal position of the dominant perforator could have a sigificant impact on blood supply of the flap. Laterally positioned perforators are favored to minimize the risk of flap necrosis, however, in case where a larger reconstructed breast volume is required, we opt for medial row perforators with broader perfusion territory.
Ugor et al. (Thu,) studied this question.