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Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques

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Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques. / Zinser, Max J; Kröger, Nadja; Malter, Wolfram; Schulz, Tino; Puesken, Michael; Mallmann, Peter; Zirk, Matthias; Schröder, Kai; Andree, Christoph; Seidenstuecker, Kathrin; Maintz, David; Smeets, Ralf; Eichler, Christian; Thamm, Oliver C; Heneweer, Carola.

In: J PERS MED, Vol. 13, No. 1, 64, 28.12.2022.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Zinser, MJ, Kröger, N, Malter, W, Schulz, T, Puesken, M, Mallmann, P, Zirk, M, Schröder, K, Andree, C, Seidenstuecker, K, Maintz, D, Smeets, R, Eichler, C, Thamm, OC & Heneweer, C 2022, 'Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques', J PERS MED, vol. 13, no. 1, 64. https://doi.org/10.3390/jpm13010064

APA

Zinser, M. J., Kröger, N., Malter, W., Schulz, T., Puesken, M., Mallmann, P., Zirk, M., Schröder, K., Andree, C., Seidenstuecker, K., Maintz, D., Smeets, R., Eichler, C., Thamm, O. C., & Heneweer, C. (2022). Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques. J PERS MED, 13(1), [64]. https://doi.org/10.3390/jpm13010064

Vancouver

Zinser MJ, Kröger N, Malter W, Schulz T, Puesken M, Mallmann P et al. Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques. J PERS MED. 2022 Dec 28;13(1). 64. https://doi.org/10.3390/jpm13010064

Bibtex

@article{7b8dad0d08a54a059f2217bfed8ec476,
title = "Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques",
abstract = "Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (∆L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall-Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (∆L = 2.85 mm) and BCEUS (∆L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming.",
author = "Zinser, {Max J} and Nadja Kr{\"o}ger and Wolfram Malter and Tino Schulz and Michael Puesken and Peter Mallmann and Matthias Zirk and Kai Schr{\"o}der and Christoph Andree and Kathrin Seidenstuecker and David Maintz and Ralf Smeets and Christian Eichler and Thamm, {Oliver C} and Carola Heneweer",
year = "2022",
month = dec,
day = "28",
doi = "10.3390/jpm13010064",
language = "English",
volume = "13",
journal = "J PERS MED",
issn = "2075-4426",
publisher = "MDPI Multidisciplinary Digital Publishing Institute",
number = "1",

}

RIS

TY - JOUR

T1 - Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques

AU - Zinser, Max J

AU - Kröger, Nadja

AU - Malter, Wolfram

AU - Schulz, Tino

AU - Puesken, Michael

AU - Mallmann, Peter

AU - Zirk, Matthias

AU - Schröder, Kai

AU - Andree, Christoph

AU - Seidenstuecker, Kathrin

AU - Maintz, David

AU - Smeets, Ralf

AU - Eichler, Christian

AU - Thamm, Oliver C

AU - Heneweer, Carola

PY - 2022/12/28

Y1 - 2022/12/28

N2 - Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (∆L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall-Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (∆L = 2.85 mm) and BCEUS (∆L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming.

AB - Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (∆L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall-Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (∆L = 2.85 mm) and BCEUS (∆L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming.

U2 - 10.3390/jpm13010064

DO - 10.3390/jpm13010064

M3 - SCORING: Journal article

C2 - 36675725

VL - 13

JO - J PERS MED

JF - J PERS MED

SN - 2075-4426

IS - 1

M1 - 64

ER -