Utilidad de la angioresonancia en la planificación preoperatoria de reconstrucción mamaria mediante colgajos libres abdominales DIEP, SIEA y TRAM / Usefulness of magnetic resonance angiography in the preoperative study for breast reconstruction using epigastric flaps

ABSTRACT

Background: Mammary reconstruction after surgery for breast cancer can be performed with free abdominal flaps such as DIEP (deep inferior epigastric perforator), TRAM (transverse rectus abdominis musculocutaneus) y SIEA (superficial inferior epigastric artery). Aim: To report our experience with the use of magnetic resonance angiography to plan mammary reconstruction. Material and Methods: The superficial epigastric vascular axis and the connections between the superficial and deep axis were explored with magnetic resonance angiography in 25 patients aged 32 to 63 years. Dominant perforating arteries (those with the greater caliber and predominant distribution through adipose tissue), were localized. Their intramuscular trajectory and that of the deep epigastric artery were also studied. The findings of magnetic resonance were compared with those of intraoperative Doppler ultrasound examination dissection during operation. Results: There was a 100 percent concordance between magnetic resonance findings and those of intraoperative Doppler. However in two patients a perforating artery with an adequate caliber was missed with magnetic resonance. Conclusions: Magnetic resonance angiography is useful in the planning of mammary reconstruction with epigastric flaps.

RESUMEN

Objetivos: Dar a conocer nuestra experiencia en la toma de decisiones para la reconstrucción mamaria con colgajos libres de tejido abdominal mediante angioresonancia. Materiales y Métodos: Nuestra muestra corresponde a 25 pacientes intervenidos entre los años 2007-2009. Mediante angioresonancia se exploró el eje vascular epigástrico superficial, así como las conexiones entre el sistema profundo y superficial, localizando las perforantes dominantes (las de mayor calibre y distribución predominante por la grasa), su trayecto intramuscular y estudiando el trayecto de la arteria epigástrica profunda. Resultados: Los hallazgos en la angioresonancia fueron utilizados en el mareaje preoperatorio y contrastados con los hallazgos evidenciados por la ultrasonografía y durante la disección intraoperatoria de los colgajos, siendo la información obtenida congruente en un 100 por ciento de los casos, lo que facilita la decisión del colgajo a disecar, acortando los tiempo operatorios y dando mayor seguridad al cirujano. Conclusiones: La angioresonancia es un método útil en el estudio preoperatorio otorgando el beneficio adicional de no irradiar a los pacientes.