From the Department of Plastic Surgery and the Department of Radiology, Section of Interventional Radiology, Radboud University Medical Center.
Plast Reconstr Surg. 2019 Jun;143(6):1151e-1158e. doi: 10.1097/PRS.0000000000005614.
In deep inferior epigastric perforator (DIEP) flap breast reconstructions, a free tissue flap from the abdomen is shaped into a breast and transferred to the thorax. Survival of this free flap relies on minuscule blood vessels, so-called perforators, providing blood supply to this newly molded breast. Preoperative mapping of these randomly distributed blood vessels is essential to avoid complications. The purpose of this study was to investigate whether the preoperative projection of a virtual three-dimensional plan based on computed tomographic angiography onto the abdomen leads to more correctly identified perforator locations and less operative time spent on dissecting the free flap compared to the commonly used Doppler ultrasound planning method.
The authors conducted a randomized, open, single-center, superiority trial in patients undergoing DIEP flap breast reconstruction with 1-week follow-up. Randomized participants were 60 adults (projection method, n = 33; Doppler method, n = 27) undergoing DIEP flap breast reconstruction without lymph node transfer.
Sixty patients provided 69 DIEP flaps for analysis. The projection method is capable preoperatively of displaying significantly more perforators compared to the Doppler method (61.7 ± 7.3 percent versus 41.2 ± 8.2 percent, respectively; p = 0.020)). During the procedure, flap harvest time is decreased by 19 minutes (136 ± 7 minutes versus 155 ± 7 minutes; p = 0.012). Complications were comparable across both groups.
Not only can more perforators be identified intraoperatively using the projection method compared with Doppler ultrasound, there is also a significant time reduction in harvesting the DIEP flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
在深部腹壁下动脉穿支（DIEP）皮瓣乳房重建中，从腹部切取游离组织皮瓣，塑造成乳房并转移到胸部。游离皮瓣的存活依赖于提供血液供应的微小血管，即所谓的穿支。这些随机分布的血管的术前定位对于避免并发症至关重要。本研究旨在探讨基于 CT 血管造影的虚拟三维规划术前投影是否比常用的多普勒超声规划方法更能准确识别穿支位置并减少游离皮瓣解剖的手术时间。
作者进行了一项随机、开放、单中心、优效性试验，纳入了 60 例接受 DIEP 皮瓣乳房重建的患者，随访时间为 1 周。随机分组的参与者为 60 例成年人（投影组 33 例，多普勒组 27 例），均行 DIEP 皮瓣乳房重建而不进行淋巴结转移。
60 例患者提供了 69 个 DIEP 皮瓣进行分析。与多普勒方法相比，投影方法术前能够显示更多的穿支（分别为 61.7%±7.3%和 41.2%±8.2%；p=0.020）。手术过程中，皮瓣采集时间缩短了 19 分钟（136±7 分钟与 155±7 分钟；p=0.012）。两组并发症发生率相当。
与多普勒超声相比，投影法不仅可以在术中识别更多的穿支，而且还可以显著缩短 DIEP 皮瓣的采集时间。
临床问题/证据水平：治疗性，II 级。
