Development of a software-assisted workflow for transforming CTA-derived perforator information into standardized surgical planning coordinates.

Abstract

Precise anatomical mapping of the deep inferior epigastric perforator (DIEP) flap is essential for successful breast reconstruction. Although computed tomography angiography (CTA) is the gold standard for preoperative planning, manual identification of perforators is time-consuming and subject to inter-rater variability. We aimed to validate a self-developed image-processing tool designed to standardize coordinate extraction and automate two-dimensional spatial mapping of pre-selected abdominal wall perforators. A retrospective analysis was conducted on 52 patients who underwent DIEP flap reconstruction between 2017 and 2021. A total of 170 perforators were analyzed. The custom software processed axial CTA slices through histogram analysis and frequency-range filtering (1800-2200 HU) to enhance vascular visualization. Cartesian coordinates of clinician-selected perforators were calculated relative to the navel base (0, 0) and compared with manual radiological assessments to validate spatial fidelity. Analysis of 170 cutaneous perforators (n=52) showed predominant concentration in the lower abdominal quadrants. Centroids were (1.4, -20.2) mm for radiological assessment and (1.8, -21.2) mm for our software, relative to the umbilicus. Validation demonstrated high concordance, with a minimal systematic bias of (-0.4, 1.0) mm and a root mean square error of 6.04 mm, within clinically acceptable margins. Standardized mapping and visual report generation averaged 8 ± 6 min per patient, thereby providing a rapid turnaround for converting coordinate data into a standardized surgical guide. The validated tool provides a reliable, objective framework for standardizing and visualizing existing radiological data in DIEP flap planning. Although it does not alter clinical perforator selection or advance surgical technique, this technical utility provides an autonomous data-processing pathway to generate standardized spatial roadmaps, thereby optimizing the preoperative imaging workflow and safeguarding administrative timelines against potential interdepartmental reporting bottlenecks.