Radiology, Vol 192, 447-450, Copyright © 1994 by Radiological Society of North America
Color Doppler flow mapping of abdominal wall perforating arteries for transverse rectus abdominis myocutaneous flap in breast reconstruction: method and preliminary results
WA Berg, BW Chang, MR DeJong and UM Hamper
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
PURPOSE: To describe the use of color Doppler flow ultrasound (US) in
preoperative mapping of small perforating arteries in the abdominal wall
that supply the transverse rectus abdominis myocutaneous (TRAM) flap used
primarily for breast reconstruction. MATERIALS AND METHODS: With a grid
(clear x-ray film) and a high-frequency linear-array transducer, the size
and position of perforating arteries as they exit the rectus abdominis
muscle were mapped preoperatively in 35 patients. Twenty-three of these
patients had previously undergone abdominal surgery; 26 underwent
reconstruction and clinical follow-up. RESULTS: Operating time was
decreased and flap design was planned to include the largest perforating
arteries and minimize the overall abdominal wall defect. Two of the 26
patients who underwent TRAM flap reconstruction had partial flap loss: One
continued to smoke, which may have caused microvascular compromise; and a
paucity of perforating arteries was seen in the second patient. CONCLUSION:
Preoperative mapping of perforating arteries for TRAM flap reconstruction
provides a rational basis for flap design and patient selection, which may
affect flap survival.
