[Non-contrast ultrasound imaging in the preoperative planning of DIEF flap breast reconstructions]

Introduction: Given the anatomical variability of the deep epigastric vessels, a thorough preoperative planning is essential before a breast reconstruction with a deep inferior epigastric artery perforator flap. Nowadays, a number of preoperative imaging method based on ultrasound are available. Objective: The aim of our study was to evaluate the efficacy of non-contrast ultrasonography in the preoperative planning of breast reconstructions with deep inferior epigastric artery perforator flaps. Method: A single-center retrospective observational study was conducted between April 2024 and November 2024. During the preoperative planning, non-contrast ultrasonography was performed before CT angiography. The primary endpoint of this study was the localization of considerable and dominant perforators, while the secondary endpoint was the identification of the congruent donor and recipient vessels. Results: During perforator mapping, the presence of considerable and dominant perforators was investigated in 24 donor sites and 72 zones. Cohen’s kappa test showed near perfect agreement between ultrasonography and CT angiography regarding the localization of considerable and dominant perforators (K = 0.83, p<0.001 and K = 0.86, p<0.001, respectively). As to the investigation of the recipient vessels that are congruent with the donor vessels, 14 recipient sites and 56 zones were examined. According to ultrasonography, the localization of the ideal recipient vessel was different from the standard zone in one-third of the cases (5/14). The recipient and donor arteries localized with ultrasonography were congruent regarding diameter (2.1 mm vs. 2.3 mm, p = 0.23, respectively), mean systolic velocity (24.5 cm/s vs. 24.6 cm/s, p = 0.98, respectively) and mean diastolic velocity (5.1 cm/s vs. 4.6 cm/s, p = 0.48, respectively). The recipient and donor veins were also congruent regarding diameter (2.3 mm vs. 2.3 mm, p = 0.96, respectively) and velocity (6.0 cm/s vs. 5.6 cm/s, p = 0.53, respectively). Conclusion: According to our single-center experience, non-contrast ultrasonography was an effective method to localize perforators and congruent donor-recipient vessels. Our study suggests that ultrasonography may be a viable alternative to CT angiography for preoperative planning of DIEP flap breast reconstructions. Orv Hetil. 2025; 166(37): 1456–1462.