RESUMO
BACKGROUND: Abdominal CT angiography (CTA) has become an integral part of the pre-operative evaluation of patients undergoing free Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. It aids accurate delineation of perforator anatomy, assists pre-operative decision making and reduces operative time. However, such detailed imaging invariably yields a variety of incidental findings, with quoted figures of 13-36% in this setting. The purpose of this study was to identify the rate of "incidentalomas" when using DIEP CT angiography and, review how such findings influence our management. METHOD: A retrospective review was performed, looking at pre-operative scan reports of 154 consecutive patients undergoing free DIEP flap breast reconstructions between July 2008 and June 2012. RESULTS: Of 154 CTA's reviewed, 116 (75.3%) demonstrated incidental findings. In 71 patients (46.1%), these "incidentalomas" were inconsequential. However, in 37 patients (24.0%) the CTA prompted further investigations, and notably in a further 8 patients (5.2%) metastatic disease or other significant pathology was discovered which changed the operative plan. CONCLUSION: The overall rate of "incidentalomas" presented in this study is substantially higher than other similar published series, and most importantly, significantly altered the surgical management plan in 5.2% of cases. As such we would advocate that a pre-operative "staging" CTA, imaging the chest, abdomen and pelvis is useful for more than just delineation of vascular anatomy in patients undergoing DIEP flap reconstruction.
Assuntos
Artérias Epigástricas/diagnóstico por imagem , Achados Incidentais , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Angiografia/métodos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Tomada de Decisões , Artérias Epigástricas/transplante , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Pessoa de Meia-Idade , Retalho Miocutâneo/irrigação sanguínea , Retalho Miocutâneo/transplante , Retalho Perfurante/transplante , Prognóstico , Estudos Retrospectivos , Medição de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: Dissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales. METHODS: A 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications. RESULTS: A total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively. CONCLUSIONS: Funnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications.