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. 2022 Mar 16;12(3):482.
doi: 10.3390/jpm12030482.

Intraoperative Blood Flow Analysis of DIEP vs. ms-TRAM Flap Breast Reconstruction Combining Transit-Time Flowmetry and Microvascular Indocyanine Green Angiography

Alexander Geierlehner  1 , Raymund E Horch  1 , Ingo Ludolph  1 , Andreas Arkudas  1
Affiliations

Intraoperative Blood Flow Analysis of DIEP vs. ms-TRAM Flap Breast Reconstruction Combining Transit-Time Flowmetry and Microvascular Indocyanine Green Angiography

Alexander Geierlehner et al. J Pers Med. .

Abstract

Background: Vascular patency is the key element for high flap survival rates. The purpose of this study was to assess and compare the blood flow characteristics of deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis musculocutaneous (ms-TRAM) flaps for autologous breast reconstruction. Methods: This prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the measurement of blood flow volume, vascular resistance, and intrinsic transit time. Results: Twenty female patients (mean age, 52 years) received 24 free flaps (14 DIEP and 10 ms-TRAM flaps). The mean arterial blood flow of the flap in situ was 7.2 ± 1.9 mL/min in DIEP flaps and 11.5 ± 4.8 mL/min in ms-TRAM flaps (p < 0.05). After anastomosis, the mean arterial blood flow was 9.7 ± 5.6 mL/min in DIEP flaps and 13.5 ± 4.2 mL/min in ms-TRAM flaps (p = 0.07). The arterial vascular resistance of DIEP flaps was significantly higher than that of ms-TRAM flaps. The intrinsic transit time of DIEP flaps was 52 ± 18 s, and that of ms-TRAM flaps was 33 ± 11 s (p < 0.05). The flap survival rate was 100%. One DIEP flap with the highest intrinsic transit time (77 s) required surgical revision due to arterial thrombosis. Conclusion: In this study, we established the blood flow characteristics of free DIEP and ms-TRAM flaps showing different blood flow rates, vascular resistances, and intrinsic transit times. These standard values will help to determine the predictive values for vascular compromise, hence improving the safety of autologous breast reconstruction procedures.

Keywords: autologous breast reconstruction; flap imaging; free tissue transfer; indocyanine green angiography; microsurgery; perforator flaps; transit-time flowmetry.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transit-Time Flow Volume Measurement (TTFM) showing a flow volume of 10 mL/min with an Acoustic Coupling Index (ACI) of 73% using a 2 mm probe.
Figure 2
Figure 2
(A) Microvascular Indocyanine Green Angiography (mICG-A) flow curves in two selected regions of interest (ROI) (green curve: arterial flow, blue curve: venous flow). The spikes are artefacts caused by respiratory movements. (B) Delay Map obtained with FLOW800 illustrating both ROIs (green ROI placed at the artery, blue ROI placed at the vein) and picturing the two flow curves. (C) Gray-scale map of fluorescence intensity (Intensity Map) illustrating both artery and vein after anastomosis.
Figure 3
Figure 3
Arterial and venous blood flows (mL/min) at three predefined time points (F, R, AA). The bars represent means ± standard error (* indicates significant differences).
Figure 4
Figure 4
Arterial Vascular Resistance (aVR) at three predefined time points (F, R, AA). The bars represent means ± standard error (* indicates significant differences).
Figure 5
Figure 5
Arterial blood flow (ml/min) versus Intrinsic Transit Time (ITT, seconds); y = −0.182x + 19.33; p = 0.001; r2 = 0.3875; red dots = DIEP flaps; blue dots = ms-TRAM flaps.
Figure 6
Figure 6
Arterial Vascular Resistance (aVR, mmHg/mL/min) versus Intrinsic Transit Time (ITT, seconds); y = 0.1744x + 1.308; p = 0.0006; r2 = 0.4196; red dots = DIEP flaps; blue dots = ms-TRAM flaps.
See this image and copyright information in PMC

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