{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:26:50Z","timestamp":1760660810609,"version":"build-2065373602"},"reference-count":15,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPHS"],"abstract":"<jats:p>Introduction: An accurate preoperative estimation of deep inferior epigastric perforator (DIEP) flaps in breast reconstruction facilitates planning. Different methods have been proposed, but few methods have been validated for the degree of agreement with harvested volume, and none have been validated in a more significant cohort. This article aimed to validate the triangular prism method using computed tomography (CT) to estimate DIEP weight in routine clinical practice.\nMethods: The triangular prism method, previously described by Nanidis, Ridha, and Jallali, uses CT to estimate DIEP flap weight, used in clinical practice in the department, was evaluated. The study included 1 year of consecutive patients, and data were extracted from the department\u2019s free flap audit registry. Bland Altman plots with mean bias and limits of agreement (LOA) with confidence intervals were drawn to estimate agreement between the estimated and actual flap weight.\nResults and conclusions: A total of 164 DIEPs were recorded, and complete data were available for 119 DIEPs (73%). The mean estimated flap weight was 979 g (range: 251\u20132,125, SD [standard deviation] 448), and the actual flap weight was 937 g (range: 303\u20132,792, SD 461). The Bland-Altman plot showed that the estimated weight overestimated the actual weight by an average of 41 grams. However, the LOAs of \u2013530 and 614 grams far exceed the a priori set limits of maximum acceptable difference (100\u00a0grams) between the estimated and the actual flap weight. Further studies are needed regarding how the triangular prism method can be combined with clinical measurements to become an easily used and reliable tool.<\/jats:p>","DOI":"10.2340\/jphs.v60.44801","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T15:39:33Z","timestamp":1760629173000},"page":"191-195","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the triangular prism method using computed tomography to estimate DIEP flap weight in routine clinical practice \u2013 a St Andrew free flap audit registry study"],"prefix":"10.2340","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3218-0881","authenticated-orcid":false,"given":"Emma","family":"Hansson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkat","family":"Ramakrishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Sharp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thaj","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1183","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"129874","unstructured":"Patel NG, Rozen WM, Chow WT, et al. Stacked and bipedicled abdominal free flaps for breast reconstruction: Considerations for shaping. Gland Surg. 2016;5(2):115\u2013121. https:\/\/doi.org\/10.3978\/j.issn.2227-684x.2016.02.03"},{"key":"129875","doi-asserted-by":"crossref","unstructured":"Lee KT, Mun GH. Volumetric planning using computed tomographic angiography improves clinical outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg. 2016;137(5):771e\u2013780e. https:\/\/doi.org\/10.1097\/PRS.0000000000002045","DOI":"10.1097\/PRS.0000000000002045"},{"key":"129876","doi-asserted-by":"crossref","unstructured":"Roggio T, Pantelides NM, Morgan M, et al. Stacked TUG and DIEP flaps to reconstruct a single breast: Expanding the scope of autologous breast reconstruction. J Plast Reconstr Aesthet Surg. 2022;75(9):2974\u20132981. https:\/\/doi.org\/10.1016\/j.bjps.2022.06.039","DOI":"10.1016\/j.bjps.2022.06.039"},{"key":"129877","doi-asserted-by":"crossref","unstructured":"Tanna N, Barnett SL, Robinson EL, et al. Hybrid microsurgical breast reconstruction: HyFIL(R) & HyPAD techniques. Clin Plast Surg. 2023;50(2):337\u2013346. https:\/\/doi.org\/10.1016\/j.cps.2022.10.006","DOI":"10.1016\/j.cps.2022.10.006"},{"key":"129878","doi-asserted-by":"crossref","unstructured":"Mohanna PN, Farhadi J. A method of preoperatively assessing the volume of abdominal tissue available for an autologous breast reconstruction. Plast Reconstr Surg. 2012;129(4):756e\u2013757e. https:\/\/doi.org\/10.1097\/PRS.0b013e318245e8b4","DOI":"10.1097\/PRS.0b013e318245e8b4"},{"key":"129879","doi-asserted-by":"crossref","unstructured":"Woo KJ, Mun GH. Estimation of DIEP flap weight for breast reconstruction by the pinch test. Microsurgery. 2017;37(7):786\u2013792. https:\/\/doi.org\/10.1002\/micr.30217","DOI":"10.1002\/micr.30217"},{"key":"129880","doi-asserted-by":"crossref","unstructured":"Minn KW, Hong KY, Lee SW. Preoperative TRAM free flap volume estimation for breast reconstruction in lean patients. 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The use of computed tomography for the estimation of DIEP flap weights in breast reconstruction: A simple mathematical formula. J Plast Reconstr Aesthet Surg. 2014;67(10):1352\u20131356. https:\/\/doi.org\/10.1016\/j.bjps.2014.05.049","DOI":"10.1016\/j.bjps.2014.05.049"},{"key":"129884","doi-asserted-by":"crossref","unstructured":"Kato S, Mori H, Koga H, et al. The triangular prism approximation method for volume estimation of deep inferior epigastric artery perforator flap in breast reconstruction. Microsurgery. 2023;43(2):125\u2013130. https:\/\/doi.org\/10.1002\/micr.30972","DOI":"10.1002\/micr.30972"},{"key":"129885","doi-asserted-by":"crossref","unstructured":"Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307\u2013310. https:\/\/doi.org\/10.1016\/S0140-6736\u200b(86)90837-8","DOI":"10.1016\/S0140-6736(86)90837-8"},{"key":"129886","doi-asserted-by":"crossref","unstructured":"Bland JM, Altman DG. 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