Abstract
In breast reconstruction with deep inferior epigastric perforator (DIEP) flap, preoperative multi-slice CT (MSCT group ; 32 cases, 34 sides) and preoperative MSCT together with intraoperative indocyanine green fluorescent angiography (+ICG group ; 19 cases, 19 sides) evaluations were compared. The perforator was selected in MSCT to emphasize the diameter, the intramuscular course, and the venous anastomosis. In the+ICG group, angiography was used to decide the flap territory in the selected perforator. Two cases were re-operated in each group. There was no significant difference in terms of the complication rate between the groups. One perforator and no midline scar cases in the+ICG group (n=13) were evaluated in terms of the flap territory. The perforator was located 2.8 cm lateral and 1.1 cm caudal from the umbilicus, and its diameter was 1.7 mm on average in MSCT. The average territory of the fluorescent study was 16.7 cm on the pedicle side and 6.3 cm on the contralateral side, and 210 cm2 in area. The more laterally the perforator was located, the more laterally the territory was spread on the pedicle side. There was no such correlation on the contralateral side. Preoperative MSCT and intraoperative ICG angiography for DIEP flap breast reconstruction were thought to be reasonable and instructive, especially for inexperienced surgeons.
