Breast reconstruction and deep inferior epigastric perforator duplex scanning
Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap method is a microsurgical technique that involves identification and dissection of the tiny DIEPs to provide perfusion to the newly reconstructed breast following mastectomy.
Until recently, CT has been used routinely to identify the location of these vessels, but CT gives limited information and requires a large dose of contrast, which is unsuitable for patients with contrast allergy or renal disease; and exposes the patient to a large amount of radiation.
We have performed methodical investigations of the abdomen on several patients to identify the location of the DIEP vessels. When our ultrasound scan results were compared to the CT results and dissection in surgery; we found that ultrasound was equal in accuracy to CT and provides a reliable radiation and contrast free alternative along with additional information that CT cannot supply.
Along with increased accuracy, ultrasound provides information on the velocity of flow and volume flow in the DIEPs, at the point the perforator crosses the fascia. The ability to measure the volume flow can be beneficial when trying to identify a suitable vessel, as the largest vessel may not always be the most suitable, but the volume of flow through the artery should provide a good indication of how much flow the vessel will carry. Ultrasound can easily depict arteries and veins separately and therefore measure the dimension of the DIEPs, whereas CT can only measure the vein and artery together. The scan also enables us to communicate to the surgeon the length of vessel, the route the vessel takes within the muscle and the number of branches that arise from each perforator. This information can considerably reduce the amount of time the surgeon has to spend dissecting the vessel out of the muscle.
✓ Can save 17% to 34% of the cost of setting up and running a vascular laboratory
✓ Reduces capital expenditure
✓ Lowers staff and administration costs
✓ 95% of inpatients investigated the same day
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