Lop03

Abstract

INTRODUCTION:Multidetector computed tomography (MDCT) angiography is "the gold standard" for preoperative perforator selection. DIRT is based on the relationship between dermal perfusion and the change in rate and pattern of skin rewarming following a cold challenge. Can DIRT be an alternative to MDCT? METHODS AND MATERIALS: 23 patients scheduled for breast reconstruction with DIEP flap were included. Preoperatively arterial perforator sounds were located with a hand held Doppler. Afterwards a desktop fan was used to deliver a mild cold challenge to the lower abdomen. The rate and pattern of rewarming of the skin was registered with an infrared camera. The locations of first appearing hot spots on the skin were registered. Eight patients had an additional MDCT scan. RESULTS: A rapid appearing "hot spot" was associated with an arterial Doppler sound and a suitable perforator intraoperatively. All DIEP flaps survived and were based on the perforator as selected from DIRT. The selected hot spot could easily be related to a perforator on the MDCT scan. CONCLUSION: Perforator selection of DIEP flaps is facilitated with the use of DIRT. The technique is non-invasive, provides real-time information and does not require exposure to ionizing radiation or intravenous contrast medium. DIRT could be an alternative for MDCT in perforator selection.