The Influence of Flow Velocity in the Feeding Vessel on Flap Perfusion in Deep Inferior Epigastric Artery Perforator Flap

Abstract

Background Contralateral perfusion of zones II and IV is critical to estimate the amount of fat necrosis and determine intraoperative flap sacrifice during autologous breast reconstruction. We aimed to determine whether perfusion of the contralateral side was affected by the peak flow velocity in the feeding vessels in the deep inferior epigastric artery (DIEA) perforator free flap reconstructions. Methods This was a retrospective review of patients who received DIEA perforator flap for autologous breast reconstruction from February to July 2020. Intraoperative indocyanine green (ICG) angiography and measurement software (Image J) were used to validate the perfusion of the contralateral side of the flap. Peak flow in the vessels was measured with duplex color Doppler and linear correlation was used to analyze the association between perfusion and blood flow velocity. Results Forty-two patients received a DIEP flap. The average age of the patients was 48.5 years, and body mass index was 23.84 kg/m2. Peak flow velocity of the internal mammary artery (IMA) was significantly higher than that of the DIEA (p <0.05). Contralateral perfusion confirmed by ICG angiography was higher in the IMA than in the DIEA (p <0.05). A linear correlation was found between peak speed (p = 0.045) and ICG perfusion length (p = 0.00003). Conclusion The status of flap perfusion depends on the feeding vessel. The velocity of blood flow between IMA and DIEA is different, and the flap perfusion varies accordingly. Therefore, ICG angiography should be performed after anastomosis at the recipient site for an accurate assessment.

Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

“…However, the study favored performing the ICG‐A on the donor site because it facilitated the identification of the best‐perfused areas, allowed better planning, and also can help choose the best perforator. In contrast, Cho et al proposed that ICG‐A should be performed after anastomosis at the recipient site because the flap perfusion status depends on the feeding vessel (Cho et al, 2022).…”