Summary
Background
Perforator mapping using diagnostic methods facilitates deep inferior epigastric perforator
(DIEP) flap planning. Computed tomographic angiography (CTA) is a well-proven tool
for perforator mapping. However, the benefits of color Doppler ultrasonography (CDU)
are as follows: 1) CDU involves dynamic real-time examination and 2) does not use
radiation. Comparing the accuracies of both methods in a cohort of patients, this
study aimed to evaluate the learning curve of surgeon-conducted CDU perforator mapping.
Methods
Twenty patients undergoing DIEP flap breast reconstruction were enrolled in a cohort
study. All patients underwent CTA perforator mapping preoperatively. XY coordinates
of significant perforators were subtracted by a radiologist. A single surgeon (sonographer)
with minimal experience with CDU performed CDU perforator mapping, including XY coordinates
subtraction. The sonographer was blinded to the CTA data. The reference coordinates
of dissected perforators were measured during surgery. Deviations from reference coordinates
for both methods were compared, and CDU mapping learning curve was assessed using
Joinpoint Regression.
Results
We included 20 women (32 DIEP flaps and 59 dissected perforators). The mean deviation
between mapped and reference coordinates was 1.00 (0.50–1.12) cm for CDU and 0.71
(0.50–1.12) cm for CTA. The learning curve of CDU mapping showed the breaking point
after the seventh patient (≈ 21 localized perforators). After the breaking point,
no significant differences between the deviations of both methods were found (p = 0.980).
Conclusion
A limited number of examinations were needed for the surgeon to learn CDU DIEA perforator
mapping with accuracy similar to that of CTA mapping.
Keywords
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Article info
Publication history
Published online: October 15, 2022
Accepted:
October 11,
2022
Received:
May 18,
2022
Footnotes
✰Financial disclosure: The authors have no financial interest to declare concerning this article's content. No funding support was requested from any commercial source. This study was supported by the Grant Agency of Masaryk University (MUNI/A/1494/2019 and MUNI/A/1668/2020).
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
