Deep Inferior Epigastric Perforator Screening Standards Under Color Doppler Ultrasonography

Background: DIEP flap is in wide application in case of reconstructive microsurgeriesthanks to its various advantages including minimum damage to the donor site, abundantvolume and preferable donor site. In specific, since the texture and volume of DIEP flapsmatch to female patients’ breasts, it plays a profound role in breast reconstruction.However, because the perforator variates wildly whether in number or in size, it is morethan necessary to go through vessel observation and screening pre-operatively. Inprocessing patients ready to take DIEP surgeries, MDCTA, MRA and color dopplerultrasonography are most commonly adopted in perforator detection, while color dopplerultrasonography is crowned as the most trustful methods, given reason by itscharacteristics including cheap expense and zero radiation. However, the ultrasonalscreening standards for DIEP still remains a question.Objective: This research is made out to find out the difference between the turnovers ofdoppler ultrasound, MDCTA, clinical findings, to make a comment on different vesselobservation maneuvers, and therefore establishing a ultrasonal screening standardespecially set up for DIEP.Method:1.Medical imaging methods comparison:52DIEP patients were included.Their perforators were looked into under color doppler ultrasonography, while theperforator amount, site, calibre were recorded and later compared with clinical findings.2.Influence factors to DIEP: Statics including perforator number, calibre, blood flowinformation of the perforators were taken down during ultrasonal observation. Therelationship between the perforator statics and the patient’s basic information including age, BMI, smoking history were studied to find out the factors crutial to the perforatorstatus.3.The selection principles of DIEP: This research takes in37patients. The outcomeof the perforator flaps were taken down, and then studied to find out the influence ofperforators’ calibre, PS and RI on flap’s survival. Hence, the screening criteria was set upfor pre-operative perforator observation.Results:1.The color doppler ultrasound is the first choice in deep inferior epigastricperforator preoperative detection and observation.2.The number of the perforators waslinked with the BMI of patients,and the abdominal operation history of the subjectinvestigated, while the calibre with patients’ age, BMI, as well as history in smoking. Thepeak systole was in close relationship with resistant index. And the resistant index is inclose relationship with age, BMI, and the scar on the lower abdomen.3.The outcome offlap survival relies on the perforator’s calibre, instead of its peak systole and resistantindex.Conclusion:1.Color doppler ultrasound is proven to be the first choice in pre-operativevessel observation, especially in case of DIEP screening for its various advantages.2.It iswith full reason to set BMI, and the perforator calibre where it penetrates the deep fascia,as the criteria in patient preoperative adoption.3.While establishing the screeningstandards of the DIEP perforator under color doppler ultrasound, it is recommended to putcalibre in the most important ground, followed by its anatomical characters andhemodynamic properties.