Preoperative Imaging for DIEA Perforator Flaps: A Comparative Study of Computed Tomographic Angiography and Doppler Ultrasound

Abstract

Computed tomographic angiography is a valuable imaging modality for the preoperative assessment of the donor-site vascular supply for TRAM and DIEA perforator flaps.

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

“…CTA has been shown to be accurate in demonstrating the location, size, and course of perforators as small as 0.3 mm and it has the ability to create 3-D reconstructions that can be easily interpreted by the surgeon [17]. However, the technique has some major disadvantages.…”

“…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].…”

Perforator flap magnetic resonance angiography for reconstructive breast surgery: A review of 25 deep inferior epigastric and gluteal perforator artery flap patients

“…As a result, there have been significant inconsistencies with high false-positive and false-negative rates when Doppler ultrasound is compared with intraoperative findings (12)(13)(14). Although CTA has good spatial resolution and is highly sensitive (100%) and specific (100%) for precise preoperative detection of perforator location when compared with Doppler ultrasound, it has the limitation of ionizing radiation exposure (14). Some women with breast cancer may be sensitive to the use of CTA since they typically undergo extensive imaging for work-up as well as for posttreatment procedures and surveillance 5 411 444 33 6 891 908 17 7 894 869 25 8 1011 1084 73 9 1407 1420 13 10 1406 1460 54 11 810 758 52 12 1718 1736 18 13 653 616 37 14 234 176 58 15 1353 1242 111 16 1260 1144 116 17 1085 1077 8 18 1105 1073 32 19 2494 2550 56 20 880 910 30 21 1267 1292 25 22 802 982 180 (ie, mammography, CT, chest radiography, PET CT, etc) that involves the use of ionizing radiation.…”

“…Doppler ultrasound limitations include 1) inability to distinguish perforators that arise from the superficial or deep system; 2) failure to accurately locate perforators that do not exit fascia perpendicularly; 3) inability to differentiate large from small perforator arteries; and 4) inability to map anatomic vessel course through the rectus abdominus or gluteal muscles (12). As a result, there have been significant inconsistencies with high false-positive and false-negative rates when Doppler ultrasound is compared with intraoperative findings (12)(13)(14). Although CTA has good spatial resolution and is highly sensitive (100%) and specific (100%) for precise preoperative detection of perforator location when compared with Doppler ultrasound, it has the limitation of ionizing radiation exposure (14).…”

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

“…CTA is a more accurate method in detecting the course and location of perforators compared to CDU 11,16 but CDU is superior to a standalone CTA examination for measuring perforator diameters. [33][34][35] and for hemodynamic evaluation of both arterial and venous conduits of the perforator-complex. 36 In order to increase the accuracy of preoperative mapping, CDU may be used in addition to CTA.…”