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Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques

Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regar...

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Autores principales: Zinser, Max J, Kröger, Nadja, Malter, Wolfram, Schulz, Tino, Puesken, Michael, Mallmann, Peter, Zirk, Matthias, Schröder, Kai, Andree, Christoph, Seidenstuecker, Kathrin, Maintz, David, Smeets, Ralf, Eichler, Christian, Thamm, Oliver C, Heneweer, Carola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862612/
https://www.ncbi.nlm.nih.gov/pubmed/36675725
http://dx.doi.org/10.3390/jpm13010064
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author Zinser, Max J
Kröger, Nadja
Malter, Wolfram
Schulz, Tino
Puesken, Michael
Mallmann, Peter
Zirk, Matthias
Schröder, Kai
Andree, Christoph
Seidenstuecker, Kathrin
Maintz, David
Smeets, Ralf
Eichler, Christian
Thamm, Oliver C
Heneweer, Carola
author_facet Zinser, Max J
Kröger, Nadja
Malter, Wolfram
Schulz, Tino
Puesken, Michael
Mallmann, Peter
Zirk, Matthias
Schröder, Kai
Andree, Christoph
Seidenstuecker, Kathrin
Maintz, David
Smeets, Ralf
Eichler, Christian
Thamm, Oliver C
Heneweer, Carola
author_sort Zinser, Max J
collection PubMed
description Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (∆L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall–Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (∆L = 2.85 mm) and BCEUS (∆L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming.
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spelling pubmed-98626122023-01-22 Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques Zinser, Max J Kröger, Nadja Malter, Wolfram Schulz, Tino Puesken, Michael Mallmann, Peter Zirk, Matthias Schröder, Kai Andree, Christoph Seidenstuecker, Kathrin Maintz, David Smeets, Ralf Eichler, Christian Thamm, Oliver C Heneweer, Carola J Pers Med Article Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (∆L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall–Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (∆L = 2.85 mm) and BCEUS (∆L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming. MDPI 2022-12-28 /pmc/articles/PMC9862612/ /pubmed/36675725 http://dx.doi.org/10.3390/jpm13010064 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zinser, Max J
Kröger, Nadja
Malter, Wolfram
Schulz, Tino
Puesken, Michael
Mallmann, Peter
Zirk, Matthias
Schröder, Kai
Andree, Christoph
Seidenstuecker, Kathrin
Maintz, David
Smeets, Ralf
Eichler, Christian
Thamm, Oliver C
Heneweer, Carola
Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title_full Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title_fullStr Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title_full_unstemmed Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title_short Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques
title_sort preoperative perforator mapping in diep flaps for breast reconstruction. the impact of new contrast-enhanced ultrasound techniques
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862612/
https://www.ncbi.nlm.nih.gov/pubmed/36675725
http://dx.doi.org/10.3390/jpm13010064
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