Studying Deep Inferior Epigastric Perforator Flap Perfusion Using the Isolated-perfused Human Abdominal Skin Flap.

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Medical Imaging

Background:

• Deep inferior epigastric artery perforator (DIEP) flaps are crucial in reconstructive surgery.
• Accurate assessment of flap perfusion is vital for surgical success.
• Current static imaging methods have limitations in dynamic perfusion evaluation.

Purpose of the Study:

• To investigate and compare dynamic deep inferior epigastric artery perforator flap perfusion using dynamic infrared thermography (DIRT) and indocyanine green fluorescence angiography (ICG-FA).
• To evaluate the efficacy of these dynamic techniques against static methods like color dye injection and computed tomography angiography (CTA).

Main Methods:

• An ex vivo perfusion model of isolated human abdominal skin flaps was utilized.
• Perfusion patterns were assessed sequentially using DIRT, ICG-FA, color dye injection, and CTA.
• 37 vessels in 19 hemi-DIEP flaps and 1 cross-midline DIEP flap were analyzed.

Main Results:

• DIRT and ICG-FA demonstrated similar perfusion patterns, correlating well with dye injection results.
• CTA provided detailed 3-dimensional visualization of perforator anatomy.
• Variable perfusion patterns were observed in lateral and medial perforators, with potential for venous rerouting.

Conclusions:

• DIRT and ICG-FA offer comparable, reproducible, and easily interpretable results for DIEP flap perfusion assessment.
• These dynamic imaging modalities are suitable for both clinical and research settings.
• DIRT and ICG-FA enhance the understanding and evaluation of DIEP flap perfusion dynamics.