Evidence map›Paper›PMID 42304573›Full record

SynthesisMicrosurgery2026

Evaluating the Efficacy and Utility of Preoperative Computed Tomography Angiography in Perforator Flap Surgeries: A Systematic Review and Meta-Analysis.

Athena Brooks, Jessica Lemke, Anna Hornbach, Nathan Keller, Jose Foppiani, Maria J Escobar-Domingo, Noelle C Garbaccio, Jade E Smith, Theodore C Lee, Cayci Cenk and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Microsurgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Athena BrooksDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0003-1691-2007
Jessica LemkeDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0009-0005-6054-5023
Anna HornbachDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0009-0007-6179-3648
Nathan KellerDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0009-0006-6034-232X
Jose FoppianiDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Maria J Escobar-DomingoDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Noelle C GarbaccioDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Jade E SmithDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Theodore C LeeDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Cayci CenkDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Umar ChoudryDepartment of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Samuel LinDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDeep inferior epigastric artery perforator (DIEP) flaps are widely used in autologous breast reconstruction and increasingly favored due to superior patient-reported outcomes. Preoperative imaging is central to efficient and safe DIEP flap planning, yet the optimal modality remains debated. While computed tomography angiography (CTA) is recommended by ERAS protocols, concerns over radiation exposure and cost have prompted interest in alternatives such as ultrasound (US) and magnetic resonance angiography (MRA).

methodsA systematic review following PRISMA guidelines was conducted across five major databases, including clinical trials and observational studies published through 2025. Studies included patients undergoing DIEP flap reconstruction with preoperative imaging using CTA, US, MRA, or other modalities. Data extracted included imaging-to-surgical perforator correlation, operative time, complication rates, and flap outcomes. Meta-analyses and heterogeneity assessments were performed using STATA.

resultsThirty-two studies encompassing 3238 patients were included. CTA was used in nearly all studies; US, MRA, SPY/ICG, and DIRT were evaluated in a subset. Pooled perforator utilization was highest with MRA (92%), followed by CTA (87%) and US (85%). Among 2967 patients with complication data, 410 (13.8%) experienced adverse outcomes. Complication rates differed significantly across strategies. Patients utilizing US alone experienced the highest complication rates (17.3%), compared to CTA alone (13.9%) and CTA and US (10.8%). The complication rate difference between US alone patients and CTA and US alone patients was statistically greater (RR = 0.63, p = 0.0123). The complication rates between CTA alone and US alone or CTA and US were not statistically different (US alone: RR = 0.81, p = 0.1040; CTA and US: RR = 0.78, p = 0.11). Complete flap loss occurred in 8.0% of complications, partial flap loss in 14%, and fat necrosis in 19%.

conclusionCTA remains the most studied imaging modality for DIEP flap surgical planning, demonstrating high perforator utilization and low complication rates. Combining CTA with US may further improve outcomes by integrating anatomical precision with dynamic feedback. As newer, lower-risk imaging technologies emerge, comparative studies are needed to determine whether they can match or exceed the performance of CTA in DIEP reconstruction.

Indexed as

Computed Tomography AngiographyEpigastric ArteriesMammaplastyPerforator FlapPreoperative CareFemaleHumansPostoperative Complications

Identifiers

PMID42304573
PMCPMC13387860

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.