A New and Innovative Method of Preoperatively Planning and Projecting Vascular Anatomy in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial

Plast Reconstr Surg. 2019 Jun;143(6):1151e-1158e. doi: 10.1097/PRS.0000000000005614.


Background: In deep inferior epigastric perforator (DIEP) flap breast reconstructions, a free tissue flap from the abdomen is shaped into a breast and transferred to the thorax. Survival of this free flap relies on minuscule blood vessels, so-called perforators, providing blood supply to this newly molded breast. Preoperative mapping of these randomly distributed blood vessels is essential to avoid complications. The purpose of this study was to investigate whether the preoperative projection of a virtual three-dimensional plan based on computed tomographic angiography onto the abdomen leads to more correctly identified perforator locations and less operative time spent on dissecting the free flap compared to the commonly used Doppler ultrasound planning method.

Methods: The authors conducted a randomized, open, single-center, superiority trial in patients undergoing DIEP flap breast reconstruction with 1-week follow-up. Randomized participants were 60 adults (projection method, n = 33; Doppler method, n = 27) undergoing DIEP flap breast reconstruction without lymph node transfer.

Results: Sixty patients provided 69 DIEP flaps for analysis. The projection method is capable preoperatively of displaying significantly more perforators compared to the Doppler method (61.7 ± 7.3 percent versus 41.2 ± 8.2 percent, respectively; p = 0.020)). During the procedure, flap harvest time is decreased by 19 minutes (136 ± 7 minutes versus 155 ± 7 minutes; p = 0.012). Complications were comparable across both groups.

Conclusion: Not only can more perforators be identified intraoperatively using the projection method compared with Doppler ultrasound, there is also a significant time reduction in harvesting the DIEP flap.

Clinical question/level of evidence: Therapeutic, II.

Publication types

  • Comparative Study
  • Equivalence Trial
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / surgery
  • Adult
  • Computed Tomography Angiography
  • Female
  • Graft Survival / physiology
  • Humans
  • Imaging, Three-Dimensional
  • Mammaplasty / methods*
  • Operative Time
  • Patient Care Planning
  • Perforator Flap / blood supply
  • Perforator Flap / physiology*
  • Preoperative Care
  • Tissue and Organ Harvesting / methods
  • Transplant Donor Site

Associated data

  • NTR/NTR5962