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Check the Record: Remote CT Scans for Breast Flap Perforator Mapping.

Publication ,  Journal Article
Sergesketter, AR; Pyfer, BJ; Phillips, BT; Zhao, R; Hollenbeck, ST
Published in: J Reconstr Microsurg
September 2018

BACKGROUND:  Perforator mapping with computed tomography angiography (CTA) prior to autologous breast reconstruction reduces donor-site morbidity and operative time, but is costly. The aim of this study was to evaluate whether pre-existing CT scans could be used for dominant perforator identification before autologous reconstruction. METHODS:  We identified all female patients who underwent mastectomy with immediate or delayed breast reconstruction with abdominal free flaps at a single institution between 2006 and 2016. Medical records were reviewed to identify patients with pre-existing CT scans of the abdomen/pelvis. CT images were reviewed by the senior surgeon and ranked on a 1 to 3 scale to indicate utility for preoperative planning. An analysis was performed to assess financial savings and radiation avoidance associated with the use of pre-existing scans. RESULTS:  Of 301 identified patients, 44.9% (n = 135) had an available pre-existing CT. A dominant perforator was identified on 92.6% of scans. A higher proportion of dominant perforators was identified using positron emission tomography (PET)/CT scans compared with CT scans with intravenous (IV) contrast and noncontrast CTs (p < 0.0001). Compared with PET/CTs and CTs with IV contrast, the average utility score for noncontrast CTs was lower (p = 0.0001). Dominant perforators were clearly identified in patients who had both a remote CT scan and a preoperative CTA. Perforator mapping using remote CT scans yielded a projected radiation reduction of 13.2 mGy per patient and yielded a projected annual U.S. health care savings of $28,459,638. CONCLUSION:  Our study suggests that pre-existing CT scans represent a viable and economical alternative for perforator mapping before abdominal-based free flap breast reconstruction.

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Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

September 2018

Volume

34

Issue

7

Start / End Page

485 / 491

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Transplant Donor Site
  • Surgery
  • Retrospective Studies
  • Perforator Flap
  • Mastectomy
  • Mammaplasty
  • Humans
  • Female
  • Computed Tomography Angiography
 

Citation

APA
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Sergesketter, A. R., Pyfer, B. J., Phillips, B. T., Zhao, R., & Hollenbeck, S. T. (2018). Check the Record: Remote CT Scans for Breast Flap Perforator Mapping. J Reconstr Microsurg, 34(7), 485–491. https://doi.org/10.1055/s-0038-1639578
Sergesketter, Amanda R., Bryan J. Pyfer, Brett T. Phillips, Ruya Zhao, and Scott T. Hollenbeck. “Check the Record: Remote CT Scans for Breast Flap Perforator Mapping.J Reconstr Microsurg 34, no. 7 (September 2018): 485–91. https://doi.org/10.1055/s-0038-1639578.
Sergesketter AR, Pyfer BJ, Phillips BT, Zhao R, Hollenbeck ST. Check the Record: Remote CT Scans for Breast Flap Perforator Mapping. J Reconstr Microsurg. 2018 Sep;34(7):485–91.
Sergesketter, Amanda R., et al. “Check the Record: Remote CT Scans for Breast Flap Perforator Mapping.J Reconstr Microsurg, vol. 34, no. 7, Sept. 2018, pp. 485–91. Pubmed, doi:10.1055/s-0038-1639578.
Sergesketter AR, Pyfer BJ, Phillips BT, Zhao R, Hollenbeck ST. Check the Record: Remote CT Scans for Breast Flap Perforator Mapping. J Reconstr Microsurg. 2018 Sep;34(7):485–491.
Journal cover image

Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

September 2018

Volume

34

Issue

7

Start / End Page

485 / 491

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Transplant Donor Site
  • Surgery
  • Retrospective Studies
  • Perforator Flap
  • Mastectomy
  • Mammaplasty
  • Humans
  • Female
  • Computed Tomography Angiography