Magnetic resonance angiography in preoperative planning of deep inferior epigastric artery perforator flaps

Accurate preoperative localisation of deep inferior epigastric artery perforator (DIEaP) provides optimal surgical planning for DIEaP flaps. Cross-sectional imaging by contrast-enhanced magnetic resonance angiography (CE-MRA) has advantages over previously described techniques for perforator imaging including reduced radiation exposure and better muscle to vessel contrast. A retrospective series of 10 unilateral free breast reconstructions following preoperative CE-MRA of the anterior abdominal wall is presented. Mean age of the patients at the time of surgery was 50.3 years (range 44-63 years). An average of 2.8 perforators per study (range 1-5) was identified. Mean perforator luminal diameter was 2.6 mm (1.4-4.0 mm) with a mean intramuscular course length of 22.3 mm (6.4-51.9 mm). Perforator course length was classified as 17% long intramuscular course (>4 cm), 80% short intramuscular course (<4 cm) and 3% paramedian. In all 10 patients, DIEaP flaps were successfully elevated. In all cases the flaps were elevated on vessels identified in preoperative review of the CE-MRA. There was a significant difference in the rates of conversion from DIEaP to transverse rectus abdominis myocutaneous (TRAM) flaps in the group who underwent CE-MRA in comparison to historical controls from the previous year (P = 0.025). CE-MRA is an effective tool for DIEaP flap planning.