Color Doppler flow mapping of abdominal wall perforating arteries for transverse rectus abdominis myocutaneous flap in breast reconstruction: method and preliminary results.
OBJECTIVE
To describe the use of color Doppler flow ultrasound (US) in preoperative mapping of small perforating arteries in the abdominal wall that supply the transverse rectus abdominis myocutaneous (TRAM) flap used primarily for breast reconstruction.


METHODS
With a grid (clear x-ray film) and a high-frequency linear-array transducer, the size and position of perforating arteries as they exit the rectus abdominis muscle were mapped preoperatively in 35 patients. Twenty-three of these patients had previously undergone abdominal surgery; 26 underwent reconstruction and clinical follow-up.


RESULTS
Operating time was decreased and flap design was planned to include the largest perforating arteries and minimize the overall abdominal wall defect. Two of the 26 patients who underwent TRAM flap reconstruction had partial flap loss: One continued to smoke, which may have caused microvascular compromise; and a paucity of perforating arteries was seen in the second patient.


CONCLUSIONS
Preoperative mapping of perforating arteries for TRAM flap reconstruction provides a rational basis for flap design and patient selection, which may affect flap survival.
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
W A
WA
Berg
B W
BW
Chang
M R
MR
DeJong
U M
UM
Hamper
D000009:Abdominal Muscles / Q000098:blood supply*; D001158:Arteries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D013524:Surgical Flaps / Q000379:methods; D014463:Ultrasonography / Q000379:methods