Perfusion of the diep flaps: A systematic review with meta‐analysis

Lee, Kyeong‐Tae; Mun, Goo‐Hyun

doi:10.1002/micr.30024

Cited by 26 publications

(18 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before surgery, perforators contribute to the perfusion of the blood vessels in the watershed zones between their perforasomes and create a pressure equilibrium that becomes disrupted with flap dissection. 21 Vessel manipulation and local accumulation of blood following ligation of perforators may further temporarily influence the flow characteristics of the selected perforator. Anatomical studies have described the existence of direct and indirect linking vessels between perforasomes.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

Chaudhry

Mercer

Weerd

2021

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: There are no in vivo studies that evaluate the effect of perforator dissection on the perfusion territory of a perforator (perforasome). In this study, indocyanine green fluorescence angiography (ICG-FA) and infrared thermography (IRT) were used intraoperatively to evaluate perforasome perfusion in hemi-DIEP flaps. Methods: Patients selected for DIEP breast reconstruction were prospectively included in the study. Preoperative perforator mapping was performed with CTA and handheld Doppler ultrasound. In general anesthesia, perforasome perfusion was evaluated with ICG-FA and IRT both before surgery and after flap dissection with preserved dominant perforators. Results: Thirty hemi-DIEP flaps were dissected in 15 patients (average BMI 26.6 kg/m 2 ), of which 40% had been operated on in the lower abdomen. Fluorescence spots from ICG were associated with infrared radiation hotspots on IRT and these corresponded with the locations of the selected perforators. IRT and ICG-FA demonstrated similar patterns in perforasome perfusion before and after perforator dissection. Perforator dissection changed the perforasome perfusion. IRT made it possible to continuously monitor the perforator activity during surgery. ICG-FA easily identified areas with impaired flap perfusion due to previous surgery. Conclusions: Perforasome perfusion is a dynamic process that changes with perforator dissection. ICG-FA and IRT are reproducible techniques for in vivo evaluation of perforasome perfusion and produce comparable results.

show abstract

Section: Discussionmentioning

confidence: 99%

In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

Chaudhry

Mercer

Weerd

2021

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…Lee et al . recently published a meta-analysis of relevant clinical and anatomical DIEP flap perfusion studies [20]. It is universally held that Hartrampf zone I is the best perfused tissue and Hartrampf zone IV, the less perfused one.…”

Section: Discussionmentioning

confidence: 99%

“…In our population, medial row perforators of pararectal origin seemed to be associated with the best flap perfusion (assessed by quantitative parameters), although statistical significance was not reached. In anatomical studies, medial row perforators are described as having a greater perfusion territory than lateral ones, crossing the midline and extending to the four zones [20]. Moreover, the fact that the perimuscular path is much easier to follow during medial row perforator dissection and the fact that lateral perforator dissection expose to higher risk of nerve damage, suggest the preferential use of medial row perforators in unilateral DIEP flap breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Innovative DIEP flap perfusion evaluation tool: Qualitative and quantitative analysis of indocyanine green-based fluorescence angiography with the SPY-Q proprietary software

et al. 2019

View full text Add to dashboard Cite

Background Perfusion-related complications remain the most common concern in DIEP flap breast reconstruction. Indocyanine green-based fluorescence angiography can be used for the real-time intra operative assessment of flap perfusion. The SPY Elite system is the most widely used device in this setting. The main objective was to describe the use of SPY-Q proprietary software to perform qualitative and quantitative analysis of flap perfusion. Methods This retrospective cohort study was performed at the Curie Institute between 2013 and 2017. We included patients undergoing unilateral DIEP flap breast reconstruction for whom indocyanine green-based angiography videos were of sufficient quality for analysis. Videos were recorded with the SPY Elite System and analyzed with SPY-Q proprietary software. Results We included 40 patients. We used real-time dynamic color analysis to describe three different patterns of flap perfusion. SPY-Q proprietary software provides quantitative flap perfusion parameters. Our quantitative analysis confirmed that zone I is the best perfused part of the flap and zone IV the less perfused one. There was no significant association between flap perfusion pattern and perforator anatomy, patients’ clinical characteristics or postoperative outcomes. After exploratory univariate analysis, quantitative perfusion parameters were significantly impaired in young patients with diabetes mellitus or under hormone therapy by tamoxifen. Conclusions We here describe a new approach to assess DIEP flap perfusion using the SPY Elite System proprietary software. It provides interesting qualitative and quantitative analysis that can be used in further studies to precisely assess DIEP flap perfusion.

show abstract

“…The vascular anatomy, perfusion zone, and clinical application of the DIEP flap have been widely reported (Hartrampf, Scheflan, & Black, ; Itoh & Arai, ; Wong et al, ). Although the dominant perforator was either the medial or lateral row perforator (Rozen et al, ; Tansatit, Chokrungvaranont, Sanguansit, & Wanidchaphloi, ), when using a DIEP flap for breast reconstruction, the following rule should be applied: when the flap crosses the abdominal midline, the medial perforator is indicated; otherwise, the lateral perforator is recommended (Hallock, ; Lee & Mun, ; Rozen et al, ; Wong et al, ). After Scheflan and Dinner (, ) and Hartrampf et al () introduced the classic perfusion zone concept, several authors revised the perfusion model of the DIEP flap (Holm, Mayr, Hofter, & Ninkovic, ; Rozen et al, ; Saint‐Cyr, ).…”

Section: Discussionmentioning

confidence: 99%

“…After Scheflan and Dinner (, ) and Hartrampf et al () introduced the classic perfusion zone concept, several authors revised the perfusion model of the DIEP flap (Holm, Mayr, Hofter, & Ninkovic, ; Rozen et al, ; Saint‐Cyr, ). Saint‐Cyr's perfusion model was the latest model to elucidate the perfusion pattern of the DIEP flap (Lee & Mun, ; Saint‐Cyr, ). This perfusion model was based on perforasome distribution and explained the perfusion and survival area differences between the medial and lateral row perforators.…”

Section: Discussionmentioning

confidence: 99%

Effect of a nondominant perforator on multiterritory perforator flap survival in rats

Wang

Yan

et al. 2019

Microsurgery

View full text Add to dashboard Cite

Background During flap surgery, the dominant perforator is usually selected as the pedicle. This study investigated the effect of a nondominant perforator on multiterritory perforator flap survival. Methods The deep circumflex iliac artery perforator flap (DCIA flap) and intercostal artery perforator flap (ICA flap) were performed (n = 12). Only the pedicle was different between the two flaps. The DCIA flap was based on the right and peripheral DCIA with three dynamic and two potential perforasomes. The ICA flap was based on the right and central ICA with five dynamic perforasomes. All adjacent perforators were ligated except the pedicle. On postoperative day 7, flap viability, angiography findings, and perfusion were compared. Results Even though the diameter of DCIA (mm) was larger than that of ICA (0.49 ± 0.03 vs. 0.4 ± 0.04; p < .05), the ICA flap survival rate (%) was higher than that of DCIA flap (99.5 ± 0.7 vs. 83.8 ± 3.9; p < .001). Based on a dominant perforator, a necrotic area was observed in the potential perforasomes of the DCIA flap. The choke vessels between the anatomical and dynamic perforasomes dilated postoperatively in the two flaps, whereas the others did not. The perfusion (PU) differences between the DCIA and ICA flaps in the dynamic perforasomes were nonsignificant (average, 342.4 ± 9.1 vs. 347.3 ± 7.3; p > .05). Conclusion Increasing the number of dynamic perforasomes had no effect on flap survival, even based on a nondominant perforator. And the pedicle position affected flap survival.

show abstract

Perfusion of the diep flaps: A systematic review with meta‐analysis

Cited by 26 publications

References 41 publications

In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

Innovative DIEP flap perfusion evaluation tool: Qualitative and quantitative analysis of indocyanine green-based fluorescence angiography with the SPY-Q proprietary software

Effect of a nondominant perforator on multiterritory perforator flap survival in rats

Contact Info

Product

Resources

About