Current Applications of Ultrasound Imaging in the Preoperative Planning of DIEP Flaps

Carolina Torres Perez-Iglesias; Elizabeth Laikhter; Christine O. Kang; Amer H. Nassar; Amy M. Maselli; Ryan Cauley; Bernard T. Lee

doi:10.1055/s-0041-1740955

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2022; 38(03): 221-227
DOI: 10.1055/s-0041-1740955

Review Article

Current Applications of Ultrasound Imaging in the Preoperative Planning of DIEP Flaps

Authors

Carolina Torres Perez-Iglesias

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Elizabeth Laikhter

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Christine O. Kang

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Amer H. Nassar

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Amy M. Maselli

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Ryan Cauley

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Bernard T. Lee

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Abstract

Background The deep inferior epigastric artery perforator (DIEP) flap has become the gold standard for autologous breast reconstruction at many institutions. Although the deep inferior epigastric artery displays significant anatomic variability in its intramuscular course, branching pattern and location of perforating vessels, the ability to preoperatively visualize and map relevant vascular anatomy has increased the efficiency, safety and reliability of the DIEP flap. While computed tomography angiography (CTA) is often cited as the preoperative imaging modality of choice for perforator flaps, more recent advances in ultrasound technology have made it an increasingly attractive alternative.

Methods An extensive literature review was performed to identify the most common applications of ultrasound technology in the preoperative planning of DIEP flaps.

Results This review demonstrated that multiple potential uses for ultrasound technology in DIEP flap reconstruction including preoperative perforator mapping, evaluation of the superficial inferior epigastric system and as a potential adjunct in flap delay procedures. Available studies suggest that ultrasound compares favorably to other widely-used imaging modalities for these indications.

Conclusion This article presents an in-depth review of the current applications of ultrasound in the preoperative planning of DIEP flaps and explores some potential areas for future investigation.

Keywords

ultrasonography - duplex ultrasonography - DIEP flap - breast reconstruction - preoperative planning

Full Text

References

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