Duplex ultrasound imaging in free transverse rectus abdominis muscle, deep inferior epigastric artery perforator, and superior gluteal artery perforator flaps: early and long-term comparison of perfusion changes in free flaps following breast reconstruction.
OBJECTIVE
Our objective was to assess the hemodynamic differences in free DIEP (deep inferior epigastric artery perforator flap), S-GAP (superior gluteal artery perforator flap) flaps versus TRAM (transverse rectus abdominis muscle) flaps and to analyze any perfusion change due to perforator dissection (study 1). To examine the hypothesis as to whether flap perfusion is maintained through the pedicle (study 2), we also compared short- and long-term DIEP flap perfusion.


METHODS
Blood volume flow, velocity, and diameter of the donor and recipient vessels of 4 TRAM flaps, 5 S-GAP flaps, and 17 DIEP flaps were examined preoperatively on day 5 and also 18 months postoperatively using duplex ultrasound.


RESULTS
The greatest volume flow and velocity are measured in the TRAM flaps, followed by S-GAP and DIEP flaps. Blood flow in the musculocutaneous and perforator flaps is twice as great as in the donor vessels, which is proof of flap hyperperfusion.


CONCLUSIONS
The minimum perfusion requirement is easily satisfied in musculocutaneus and free perforator flaps. In the long term, DIEP flap perfusion increases 13%, which assumes that DIEP flap perfusion is maintained on the pedicle.
Heitland
Andreas S
AS
Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Aachen, Aachen University of Technology, Aachen, Germany. dr-heitland@t-online.de
Markowicz
Martha
M
Koellensperger
Eva
E
Schoth
Felix
F
Feller
Axel-Mario
AM
Pallua
Norbert
N
D000714:Anastomosis, Surgical; D001158:Arteries / Q000000981:diagnostic imaging / Q000637:transplantation; D001810:Blood Volume; D001940:Breast / Q000098:blood supply* / Q000601:surgery*; D002081:Buttocks / Q000098:blood supply*; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000637:transplantation*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D017568:Rectus Abdominis / Q000000981:diagnostic imaging* / Q000637:transplantation*; D012039:Regional Blood Flow; D013524:Surgical Flaps / Q000098:blood supply*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods