Refining perforator selection for DIEP breast reconstruction using transit time flow volume measurements

Area of Science:

• Vascular Surgery
• Microsurgery
• Medical Imaging

Background:

• Transit time flow volume (TTFV) is established for assessing small vessel flow in cardiac surgery.
• Deep inferior epigastric artery perforator (DIEP) flap harvesting requires precise identification of perforator vessels.
• Current methods for perforator assessment may have limitations.

Purpose of the Study:

• To evaluate the utility of TTFV in assessing perforator vessels during DIEP flap harvesting.
• To correlate TTFV measurements with computed tomographic angiography (CTA) and hand-held Doppler signals.
• To determine the accuracy of TTFV in identifying arterial perforators.

Main Methods:

• Prospective evaluation of ten free DIEP breast reconstructions.
• Preoperative CTA to identify abdominal wall perforators.
• Intraoperative assessment of perforators (>1 mm) using hand-held Doppler and TTFV device.
• Correlation of vessel location, waveform patterns, and TTFV with CTA and Doppler findings.

Main Results:

• TTFV demonstrated arterial flow waveforms in 15 of 16 CTA-identified perforators and 2 additional vessels.
• TTFV achieved 94% sensitivity and 95% specificity in identifying arterial perforators.
• Hand-held Doppler was misleading in 70% of assessed vessels.
• TTFV effectively distinguished arterial from venous waveforms, even when Doppler signals were ambiguous.

Conclusions:

• TTFV is a highly accurate tool for identifying arterial perforators in DIEP flap harvesting.
• CTA and TTFV show strong correlation, enhancing perforator vessel assessment.
• Utilizing TTFV may help prevent poor flap perfusion and improve surgical outcomes.