Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Appraisal Of Perforasomes And Venosomes Of Perforators In Bilateral Diep Breast Reconstruction Using Updated SpyQ Analysis
Anita T. Mohan, MRCS MBBS BSc, L Zhu, MD, Samir Mardini, MD, Steven Moran, MD, Michel Saint-Cyr, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE: The perfusion territories of the lower abdomen have been studied both in extensive cadaveric studies and rudimentary assessments in small studies in-vivo. Bilateral breast reconstructions make up the majority of current practice in the USA, and there is a dearth of data available specifically focused on harvest of hemi-abdominal Deep Inferior Epigastric Perforator (DIEP) flaps. The aim of this study was to assess real-time physiology of perforasomes and venosomes and compare perforator location with in-vivo physiological patterns using a beta SPYQ software updated for detailed quantitative intra-operative assessment.
METHODS: 40 hemi-DIEP flaps for breast reconstruction have been assessed using indocyanine green laser angiography for arterial assessment and 16 flaps included venous studies using the beta SPYQ updated software. Each flap was based on a single dominant perforator. An evaluation of overall perfusion intensity and rate of flow over time will be mapped out for the flap. Assessment of the relative area of the flap that is perfused greater than 75%, 50% and 25% with reference to the perforator will be calculated. Gradients of perfusion in the caudal-cephalad axis and medial to lateral axis of the flap will be reviewed. Both arterial and venous systems will be evaluated in this study.
RESULTS: There was no difference between overall area of perfusion between medial and lateral row perforators if based on a single dominant perforator in the hemi_DIEP. Perfusion gradients remained more consistent in the cranio-caudal axis except some paraumbilical/medial row perforators had a more circular pattern of both intensity and rate of blood flow, and this was reflected in a slight drop in perfusion caudally, which was not critical. In both lateral and medial row perforators there was a slower perfusion in the most lateral portion of the flap. There was no current difference elicited in flaps that had an additional perforator.
CONCLUSION: Cadaveric studies can provide important details on vascular architecture but quantitative analysis intra-operatively can provide additional pertinent information that will bridge the gap of understanding blood flow dynamics of individual perforators in fasciocutaneous flaps. This is part of an ongoing protocol development and basis for further study.


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