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The Butterly iQ: An ultra-simplified color Doppler ultrasound for bedside pre-operative perforator mapping in DIEP flap breast reconstruction

Published:January 18, 2020DOI:https://doi.org/10.1016/j.bjps.2020.01.002
      The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction.
      • Man L.-.X.
      • Selber J.C.
      • Serletti J.M.
      Abdominal wall following free tram or DIEP flap reconstruction: a meta-analysis and critical review.
      The muscle preserving technique is more challenging and time-consuming due to inconsistency of the vascular anatomy of the inferior abdominal vessels, and the position, pathway and caliber of the perforators.
      • Cina A.
      • Salgarello M.
      • Barone-Adesi L.
      • Rinaldi P.
      • Bonomo L.
      Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler us.
      Pre-operative planning has enabled accurate, simplified and efficient flap harvesting with assistance of Computerised or Magnetic Angiography, or Ultrasonography.
      • Cina A.
      • Salgarello M.
      • Barone-Adesi L.
      • Rinaldi P.
      • Bonomo L.
      Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler us.
      ,
      • Weum S.
      • Mercer J.B.
      • de Weerd L.
      Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study.
      Computed Tomographic Angiography (CTA) is a commonly used standardised, reproducible investigation that allows accurate demonstration of vessel course, branching, and the location of the abdominal perforators.
      • Cina A.
      • Salgarello M.
      • Barone-Adesi L.
      • Rinaldi P.
      • Bonomo L.
      Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler us.
      Color Doppler Ultrasound (CDU) is a safe alternative technique that allows radiation-free dynamic pre-operative perforator mapping, but it is use is subjective and based on the experience of the operator. Recent studies have compared CTA, CDU and Magnetic Resonance Angiography (MRA).
      • Cina A.
      • Salgarello M.
      • Barone-Adesi L.
      • Rinaldi P.
      • Bonomo L.
      Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler us.
      ,
      • Weum S.
      • Mercer J.B.
      • de Weerd L.
      Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study.
      Newer promising imaging modalities such as dynamic infrared thermography, or laser assisted indocyanine green fluorescent angiography may offer more intra-operative perfusion control planning.
      • Weum S.
      • Mercer J.B.
      • de Weerd L.
      Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study.
      ,
      • Chae M.P.
      • Hunter-Smith D.J.
      • Rozen W.M.
      Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction.
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      References

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