J Reconstr Microsurg 2009; 25(2): 139-145
DOI: 10.1055/s-0028-1103500
© Thieme Medical Publishers

Early and Long-Term Evaluation of Perfusion Changes in Free DIEP-Flaps for Breast Reconstruction via IC-View and Duplex Ultrasound: Autonomous or Peripheral Perfusion?

Andreas S. Heitland1 , Marta P. Markowicz1 , Eva Koellensperger1 , Felix Schoth2 , Norbert Pallua1
  • 1Department of Plastic Surgery, Hand Surgery - Burn Unit, RWTH Aachen University, Aachen, Germany
  • 2Department of Radiology, RWTH Aachen University, Aachen, Germany
Further Information

Publication History

Publication Date:
02 January 2009 (online)

ABSTRACT

Controversy surrounds the question whether free flaps remain dependent for blood supply on their vascular pedicle or if there is an autonomization by neovascularization from the surrounding wound bed. This becomes important when flap shaping or repositioning are performed. Our study involved 23 patients who received a deep inferior epigastric perforator (DIEP) flap for breast reconstruction. IC-View laser video angiography (Pulsion Medical Systems AG, Munich, Germany) was executed immediately and 18 months postoperatively. Two zones (close and distant to the pedicle) and the contralateral breast were compared quantitatively. Via duplex ultrasound, late perfusion changes were measured to analyze flow volume, velocity, and diameter of the internal thoracic artery and the DIEP-flap pedicle. In the long term, early postoperative flap hyperperfusion changed to flap hypoperfusion. No enhanced flow from the flap surrounding into the flap borders was measured. These results might indicate a long-term increase in total peripheral vascular resistance of the transplanted tissue. Postoperative perfusion after 18 months remains dependent on the anastomosed vascular pedicle.

REFERENCES

  • 1 Machens H G, Mailander P, Brenner P et al.. Does tissue perfusion after free microvascular tissue transplantation remain autonomous?.  Handchir Mikrochir Plast Chir. 2000;  32(3) 193-196
  • 2 Machens H G, Pallua N, Pasel J, Mailaender P, Liebau J, Berger A. Persistence of pedicle blood flow up to 10 years after free musculocutaneous tissue transfer.  Plast Reconstr Surg. 1998;  101(3) 719-726
  • 3 Still J, Law E, Dawson J, Bracci S, Island T, Holtz J. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green.  Ann Plast Surg. 1999;  42(3) 266-274
  • 4 Holm C, Mayr M, Hofter E et al.. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green.  Br J Plast Surg. 2002;  55(8) 635-644
  • 5 Rubben A, Eren S, Krein R, Younossi H, Bohler U, Wienert V. Infrared videoangiofluorography of the skin with indocyanine green—rat random cutaneous flap model and results in man.  Microvasc Res. 1994;  47(2) 240-251
  • 6 Sheridan R L, Schomaker K T, Lucchina L C et al.. Burn depth estimation by use of indocyanine green fluorescence: initial human trial.  J Burn Care Rehabil. 1995;  16(6) 602-604
  • 7 Jerath M R, Schomacker K T, Sheridan R L, Nishioka N S. Burn wound assessment in porcine skin using indocyanine green fluorescence.  J Trauma. 1999;  46(6) 1085-1088
  • 8 Green H A, Bua D, Anderson R R, Nishioka N S. Burn depth estimation using indocyanine green fluorescence.  Arch Dermatol. 1992;  128(1) 43-49
  • 9 Still J M, Law E J, Klavuhn K G, Island T C, Holtz J Z. Diagnosis of burn depth using laser-induced indocyanine green fluorescence: a preliminary clinical trial.  Burns. 2001;  27(4) 364-371
  • 10 Hoer J, Tons C, Schachtrupp A et al.. Quantitative evaluation of abdominal wall perfusion after different types of laparotomy closure using laser-fluorescence videography.  Hernia. 2002;  6(1) 11-16
  • 11 Holm C, Tegeler J, Mayr M et al.. Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience.  Microsurgery. 2002;  22(7) 278-287
  • 12 Heitland A, Feller A. Prä- und postoperative Duplexsonographie bei freien Lappenplastiken. 30. Jahreskongress der VDPC (Vereinigung der deutschen Plastischen Chirurgen) Pre- and postoperative duplexultrasonography in free flaps. 30th Conference of the VDCP September 15–16, 1999
  • 13 Salgado C J, Smith A, Kim S et al.. Effects of late loss of arterial inflow on free flap survival.  J Reconstr Microsurg. 2002;  18(7) 579-584
  • 14 Fisher J, Wood M B. Late necrosis of a latissimus dorsi free flap.  Plast Reconstr Surg. 1984;  74(2) 274-281
  • 15 Rothaus K O, Acland R D. Free flap neo-vascularisation: case report.  Br J Plast Surg. 1983;  36(3) 348-349
  • 16 Khoo C T, Bailey B N. The behavior of free muscle and musculocutaneus flaps after early loss of axial blood supply.  Br J Plast Surg. 1982;  35(1) 43-46

Andreas S Heitland
M.D. Marta P MarkowiczM.D. 

Plastic Surgery, Hand Surgery - Burn Center, RWTH Aachen University, Pauwelsstrasse 30

52074 Aachen, Germany

Email: dr.heitland@yahoo.de

Email: m.markowicz@t-online.de