Semiautomatic Quantitative Assessment of DIEP Flap Volume and Thickness for Breast Reconstruction using CTA Data and Implications in Postoperative Complications

Abstract

Summary: Accurately assessing flap volume and thickness is a crucial aspect of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap, especially in challenging cases such as thin or large-breasted women or bilateral reconstruction. To address this, we present an innovative image processing tool utilizing computed tomography angiography (CTA) to measure DIEP flap volume and thickness. Our approach incorporates an elliptical equation validated on DIEP reconstruction patients. Preoperative abdominal CTA images were obtained from 70 patients who underwent DIEP flap breast reconstruction at Hospital Universitari de Bellvitge from 2017 to 2021. The image processing tool was employed for preoperative quantification, utilizing elliptical approximations, to determine the volume to be harvested and assess the central thickness of the flap. Subsequently, a non-parametric statistical retrospective analysis was conducted to examine these parameters in relation to immediate complications. The mean maximum recruitable volume (MRV) was 1017.15 ± 325.51 cm³, with a mean thickness of 3.65 ± 1.14 cm. No significant correlation was found between postoperative complications and MRV or thickness values. The processing tool offers a reliable solution for accurately measuring the volume and thickness of the DIEP flap from CTA images, aiding surgeons in breast reconstruction decision-making. This innovative approach enhances surgical planning by addressing quantitative values of thickness and volume of the DIEP flap, which is critical for accurate flap assessment.

Keywords

• DIEP flap
• Image processing algorithm
• Computed tomography angiography
• Perforator flap planning
• 3D planning