Plastic and Reconstructive Surgery: June 2019 - Volume
143 - Issue 6 - p 1151e–1158e
by Hummelink, Stefan; Hoogeveen, Yvonne L.; Schultze Kool,
Leo J.; Ulrich, Dietmar J. O.
Background: In
deep inferior epigastric perforator (DIEP) flap breast reconstructions, a free
tissue flap from the abdomen is shaped into a breast and transferred to the
thorax. Survival of this free flap relies on minuscule blood vessels, so-called
perforators, providing blood supply to this newly molded breast. Preoperative
mapping of these randomly distributed blood vessels is essential to avoid
complications. The purpose of this study was to investigate whether the
preoperative projection of a virtual three-dimensional plan based on computed
tomographic angiography onto the abdomen leads to more correctly identified
perforator locations and less operative time spent on dissecting the free flap
compared to the commonly used Doppler ultrasound planning method.
Methods: The
authors conducted a randomized, open, single-center, superiority trial in
patients undergoing DIEP flap breast reconstruction with 1-week follow-up.
Randomized participants were 60 adults (projection method, n = 33; Doppler
method, n = 27) undergoing DIEP flap breast reconstruction without lymph node
transfer.
Results: Sixty
patients provided 69 DIEP flaps for analysis. The projection method is capable
preoperatively of displaying significantly more perforators compared to the
Doppler method (61.7 ± 7.3 percent versus 41.2 ± 8.2 percent, respectively; p =
0.020)). During the procedure, flap harvest time is decreased by 19 minutes
(136 ± 7 minutes versus 155 ± 7 minutes; p = 0.012). Complications were
comparable across both groups.
Conclusion: Not
only can more perforators be identified intraoperatively using the projection
method compared with Doppler ultrasound, there is also a significant time
reduction in harvesting the DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
