A prospective study using color flow duplex ultrasonography for abdominal perforator mapping in microvascular breast reconstruction
Katrin Seidenstucker, Beatrix Munder, Philipp Richrath, Conrad Rybacki, Raymund E. Horch, Justus P. Beier, Brian T. Andrews, Christoph Andree
Med Sci Monit 2010; 16(8): MT65-70
Available online: 2010-08-01
Background: Abdominally based perforator free flaps are commonly used in reconstructive breast surgery. Pre-operative assessment using a variety of imaging techniques has become increasingly popular to assess the anatomy of the abdominal perforators. We hypothesize that color flow duplex ultrasonography is a reliable method for mapping the abdominal perforator anatomy and avoids the complications associated with other methods.
Material/Methods: A prospective study of 40 consecutive patients was performed. Pre-operative color flow duplex ultrasound evaluation was compared to intra-operative findings of the dominant epigastric perforator selected at the time of flap harvest.
Results: Forty consecutive patients were evaluated prospectively. Forty six flaps were harvested from these patients (6 bilateral cases). A single perforator which was identified by both pre-operatively and at the time of intra-operative flap harvest as the dominant perforator was identified in 36 of 46 flaps (78.3%). The intra-operative perforator chosen at the time of flap harvest was identified as one of the pre-operative perforators marked by duplex ultrasonography in 45 or 46 patients (97.8%).
Conclusions: Pre-operative duplex ultrasonography is a safe and reliable tool for assessing the abdominal epigastric perforators used in autologous microvascular breast reconstruction. Advantages of this technique are: it is non-invasive, it does not require contrast agent application, no radiation, and it is inexpensive when compared to other imaging modalities.
Keywords: Prospective Studies, Preoperative Care, Microvessels - ultrasonography, Mammaplasty - methods, Intraoperative Care, Color, Adult, Abdomen - ultrasonography, Ultrasonography, Doppler, Duplex