The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction

Abstract

Reconstruction using perforator flaps can be technically demanding and in inexperienced hands may result in longer operative times and increased costs. This has implications for the postoperative recovery of patients as well as associated complications such as atelectasis and deep vein thrombosis. This study examined different aspects of perforator flap reconstruction including operative times, ischaemia time, flap re-exploration rate, complications and inpatient length of stay. The mean operative times were as follows: for Deep Inferior Epigastric Artery Perforator (DIEAP) flaps it was 4 h 49 min (n=17), for bilateral DIEAP it was 7 h 23 min (n=12) and for SGAP it was 4 h 56 min (n=2). Since CT preoperative perforator mapping was introduced it has resulted in a mean reduction of operative time by 1 h 16 min (21%). This has also led to costs saving of 471 pounds sterling per patient. Preoperative mapping of perforators can reduce operative times as well as allowing the selection of the most reliable perforators beforehand. Good flap perfusion is assured which leads to reduced length of stay as well as fewer complications such as postoperative fat necrosis and delayed healing. Reduced operative times also contribute to major cost savings for the hospital. Although both CT and Duplex perforator mapping can reduce operative times, this study found that operative times were reduced more after CT scanning was introduced.