Abstract:

The first option in breast reconstruction with autologous tissue is currently the abdominal perforator flap due to the similarity of this tissue and that of the breast. The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a deep inferior epigastric artery perforator (DIEP) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications1-3. Computerized models and virtual reality applications are being used to facilitate teaching and preoperative evaluation in a number of other complex anatomical regions2.
Preoperative three-dimensional (3D) reconstructions with VirSSPA software for virtual reality navigation have been used in our centre since the year 2007 for perforator flaps planning in breast reconstruction. The main objectives were to reduce surgery time and the number of complications.

In order to determine the feasibility of VirSSPA 3D software for virtual reality navigation a comparative study was conducted in 70 patients subjected to delayed breast reconstruction based on unilateral DIEP flaps. Half of the patient group underwent preoperative imaging with CTA-guided VirSSPA reconstruction while the other half was subjected to preoperative Doppler ultrasound for perforator mapping. Operation time ranges, lengths of stay, and operative complications were assessed.

Our results showed that the use of VirSSPA preoperative planning correlated with operative times reduced by a mean of 2 h and 8 min. In addition, a statistically significant reduction (>45%) in the incidence of any flap-related complications was observed in patients undergoing preoperative CTA-VirSSPA reconstruction as well as a decrease above 50% in overall donor site morbidity. The use of CTA-guided VirSSPA 3D reconstruction was found to be a protective factor against developing any kind of complication after DIEP flap surgery (OR, 0.03; 95% CI, 0.006-0.15).

VirSSPA 3D reconstruction in the assessment of perforator flaps was proved to be safe and reliable. The main benefits of this technique were to reduce surgery time and the number of complications. Likely, other exciting virtual reality applications might derive from these principles for future use in reconstructive plastic surgery. We hope that our project will contribute to the many steps that need to be taken worldwide toward such end.

References:
1. Vandevoort M, Vranckx JJ, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction. Plast Reconstr Surg 2002;109:1912.
2. Rosson GD, Williams CG, Fishman EK, et al. 3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps. Microsurgery 2007;27:641.
3. Masia J, Clavero JA, Larrañaga JR, et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstruct Aesthet Surg 2006;59:594.

Keywords:

perforator flap, preoperative planning, computer assisted surgery, reconstructive.