Current Techniques in Preoperative Imaging for Abdomen-based Perforator Flap Microsurgical Breast Reconstruction

Abstract

Perforator-based microsurgical reconstruction of the breast has steadily increased since the introduction of the technique in the 1990s. The procedure appears to offer less postoperative pain, lower abdominal morbidity, and better preservation of the rectus muscles than the more conventional flaps. However, the major disadvantage of these flaps that they can be difficult to harvest, resulting in a longer operative times. The challenges in flap dissection are a result of the variability in the vascular anatomy of the deep inferior epigastric artery (DIEA) and its perforating branches through the rectus muscle. The location, number, and caliber of the perforators and the intramuscular trajectory of the DIEA branches vary greatly not only from individual to individual, but from one hemiabdomen to the other. The establishment of a presurgical map of the vessels on the abdomen facilitates surgical planning and may decrease operating room time, reduce intraoperative complications, and possibly improve outcomes. This article reviews the available techniques for preoperative planning with the currently available imaging modalities of handheld Doppler, color Doppler (duplex) ultrasound, computed tomography angiography, and magnetic resonance angiography.

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

“…The virtually infinite number of potential donor sites, with a highly variable vascular anatomy, requires preoperative visualization and mapping of perforators [13]. Preoperative perforator mapping optimizes flap design, reduces operating time and has become standard in certain areas of reconstructive surgery, such as breast reconstruction [5,[14][15][16][17][18][19].…”

“…Unlike conventional flaps, the high technical demands associated with perforator flaps require preoperative vessel identification and mapping, in order to reduce complications [4]. Preoperative perforator mapping optimizes flap design, reduces operating times, lowers complication rates, and provides an overall better result [5].…”

“…Recent studies show no significant difference between Computer Tomography Angiography (CTA) and CDU in reducing operating times and lowering complication rates in patients undergoing breast reconstruction [7]. The main drawbacks associated with CDU are the long examination time and operator dependence [5].…”

Septocutaneous Gluteal Artery Perforator (Sc-GAP) Flap for Breast Reconstruction: How We Do It

“…Numerous radiological imaging modalities are available to identify perforator branches in advance, facilitating surgical planning and shortening operative time [18,23]. At this moment, the most widely applied modalities in the preoperative evaluation and planning of perforator flap procedures are Doppler ultrasound (DUS) and CT angiography (CTA) [18].…”

“…At this moment, the most widely applied modalities in the preoperative evaluation and planning of perforator flap procedures are Doppler ultrasound (DUS) and CT angiography (CTA) [18]. Both these imaging techniques are widely available and relatively inexpensive.…”