Dataset Information

Tracing: A Simple Interpretation Method for the DIEP Flap CT Angiography to Help Operative Decision-making.

ABSTRACT: CT angiography (CTA) is an established technique that allows preoperative planning in DIEP flap reconstruction. However, innovative technological developments with extensive amounts of information require processing of data. It also requires user knowledge to interpret findings. Descriptions by radiologists are many times disappointingly limited to caliber and exit points of the perforator from the rectus fascia. Many DIEP flap surgeons similarly fail to utilize the CTA to its full extent. This is likely due to information overload. By tracing the DIEA on the CTA on a computer screen, using an ordinary ballpoint pen and a white sheet of paper, the surgeon can create a stylistic map of the dissectional-path of the DIEA. The map illustrates unusual branching patterns, perforator caliber and location, interconnections between individual perforators (or lack thereof), length of intramuscular dissection, and also rectus abdominis muscle intersections. The mapping can help in the choice of perforator(s) and may also speed up decision-making during surgical dissection. A penciled map also eases a round-table discussion, if multiple surgeons are involved in the operation. The map can also easily be brought to the operating room for guidance. Tracing is a user-friendly, time-efficient, intuitive, low-cost, and low-tech method that generates data that are easy to interpret, easy to share, and easy to discuss with other surgeons. The method is also not dependent on a radiologist for interpretation.

SUBMITTER: Sandberg LJ

PROVIDER: S-EPMC7722613 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Tracing: A Simple Interpretation Method for the DIEP Flap CT Angiography to Help Operative Decision-making.

Sandberg Lars Johan LJ

Plastic and reconstructive surgery. Global open 20201124 11

CT angiography (CTA) is an established technique that allows preoperative planning in DIEP flap reconstruction. However, innovative technological developments with extensive amounts of information require processing of data. It also requires user knowledge to interpret findings. Descriptions by radiologists are many times disappointingly limited to caliber and exit points of the perforator from the rectus fascia. Many DIEP flap surgeons similarly fail to utilize the CTA to its full extent. This ...[more]

PMID: 33299694

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Project description:BACKGROUND:The authors investigated aesthetic outcome and patient satisfaction in women who have undergone deep inferior epigastric artery perforator (DIEP) flap reconstruction in the setting of postmastectomy radiotherapy. Patients who underwent DIEP flap reconstruction without postmastectomy radiotherapy were the control group. METHODS:Participants who had undergone DIEP flap reconstruction between September 1, 2009, and September 1, 2014, were recruited, answered the BREAST-Q, and underwent three-dimensional surface-imaging. A panel assessed the aesthetic outcome by reviewing these images. RESULTS:One hundred sixty-seven women participated. Eighty women (48 percent) underwent immediate DIEP flap reconstruction and no postmastectomy radiotherapy; 28 (17 percent) underwent immediate DIEP flap reconstruction with postmastectomy radiotherapy; 38 (23 percent) underwent simple mastectomy, postmastectomy radiotherapy, and DIEP flap reconstruction; and 21 (13 percent) underwent mastectomy with temporizing implant, postmastectomy radiotherapy, and DIEP flap reconstruction. Median satisfaction scores were significantly different among the groups (p < 0.05). Post hoc comparison demonstrated that women who had an immediate DIEP flap reconstruction were significantly less satisfied if they had postmastectomy radiotherapy. In women requiring radiotherapy, those undergoing delayed reconstruction after a simple mastectomy were most satisfied, but there was no significant difference between the immediate DIEP flap and temporizing implant groups. Median panel scores differed among groups, being significantly higher if the immediate reconstruction was not subjected to radiotherapy. There was no significant difference in panel assessment among the three groups of women who had received radiotherapy. CONCLUSIONS:Patients who avoid having their immediate DIEP flap reconstruction irradiated are more satisfied and have better aesthetic outcome than those who undergo postmastectomy radiotherapy. In women requiring radiotherapy and who wish to have an immediate or "delayed-immediate" reconstruction, there were no significant differences in panel or patient satisfaction. Therefore, immediate DIEP flap reconstruction or mastectomy with temporizing implant then DIEP flap surgery are acceptable treatment pathways in the context of post-mastectomy radiotherapy.

Project description:ObjectivesThe addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of coronary CT angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD).MethodsThis retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACEs) during the 1-year follow-up using chi-square tests for independence. Kaplan-Meier curves were used to visualize the occurrence of safety outcomes over time.ResultsA total of 360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group, and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA group, and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA), and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA, and three (2.2%) SPECT (p < 0.001 for all three options). The revascularization rate after ICA was similar between groups (p = 0.15). However, patients in the CCTA group more often underwent revascularization (p = 0.007).ConclusionAddition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after 1 year.Key points• Previous studies have shown that computed tomography-derived fractional flow reserve improves the accuracy of coronary computed tomography angiography without changes in acquisition protocols. • This study shows that use of computed tomography-derived fractional flow reserve as gatekeeper to invasive coronary angiography in patients suspected of stable coronary artery disease leads to less invasive testing and revascularization without observed difference in outcomes after 1 year. • This could lead to a significant reduction in costs, complications and (retrospectively unnecessary) usage of diagnostic testing capacity, and a significant increase in patient satisfaction.

Dataset Information

Tracing: A Simple Interpretation Method for the DIEP Flap CT Angiography to Help Operative Decision-making.

Publications

Tracing: A Simple Interpretation Method for the DIEP Flap CT Angiography to Help Operative Decision-making.

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