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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
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Publication History

Publication Date:
02 January 2009 (online)

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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.

KEYWORDS

Laser video angiography - perforator flaps - flap perfusion - autonomization

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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Fisher J, Wood M B. Late necrosis of a latissimus dorsi free flap.  Plast Reconstr Surg. 1984;  74(2) 274-281
    PubMedSearch in Google Scholar
  • 15 Rothaus K O, Acland R D. Free flap neo-vascularisation: case report.  Br J Plast Surg. 1983;  36(3) 348-349
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar

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