ABSTRACT
Perforator flaps have become increasingly popular tools in microvascular breast reconstruction.
Previous criticism of these techniques, particularly deep inferior epigastric artery
perforator (DIEAP) flap, have included the variability in the path of the perforators
through the rectus muscle, the tedious and time-consuming need to look for and to
clamp various perforators to determine the “dominant” perforator, and uncertainty
whether adequate perforators exist following previous abdominal surgery. Preoperative
imaging has contributed significantly to the reliability, speed, and minimal donor
site morbidity of these procedures. A major evolution in preoperative imaging has
been the introduction of multidetector row computed tomography (MDCT) as a replacement
for color duplex imaging. There are multiple advantages to MDCT with few disadvantages,
and so it has become the gold standard for the preoperative planning of DIEAP flap
breast reconstruction in the practices of both authors, completely eliminating the
use of color duplex. Improvements in the preoperative understanding of the anatomy
of each perforator from its branching pattern in the subcutaneous fat, to its perforation
through the anterior rectus sheath and rectus muscle toward the groin facilitate this
type of surgery in a manner only possible with MDCT and not duplex imaging.
KEYWORDS
Breast reconstruction - DIEAP flap - CT angiography - duplex flowmetry - preoperative
planning
REFERENCES
Surgical-technical aspects of the free DIEP flap for breast reconstruction . In: Blondeel PN SM, Hallock GG, Neligan PC Perforator flaps: anatomy, techniques
and clinical applications. 1st ed. St. Louis, MO; Quality Medical Publishers 2006:
627-637 Ultrasound evaluation of perforator vessels . In: Blondeel PN, Hallock GG, Neligan PC Perforator Flaps: Anatomy, Techniques, and
Clinical Applications. 1st ed. St. Louis, MO; Quality Medical Publications 2006: 92-102
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