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A New and Innovative Method of Preoperatively Planning and Projecting Vascular Anatomy in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial

Hummelink, Stefan Ph.D.; Hoogeveen, Yvonne L. Ph.D.; Schultze Kool, Leo J. M.D., Ph.D.; Ulrich, Dietmar J. O. M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1151e-1158e
doi: 10.1097/PRS.0000000000005614
Breast: Original Articles

Background: In deep inferior epigastric perforator (DIEP) flap breast reconstructions, a free tissue flap from the abdomen is shaped into a breast and transferred to the thorax. Survival of this free flap relies on minuscule blood vessels, so-called perforators, providing blood supply to this newly molded breast. Preoperative mapping of these randomly distributed blood vessels is essential to avoid complications. The purpose of this study was to investigate whether the preoperative projection of a virtual three-dimensional plan based on computed tomographic angiography onto the abdomen leads to more correctly identified perforator locations and less operative time spent on dissecting the free flap compared to the commonly used Doppler ultrasound planning method.

Methods: The authors conducted a randomized, open, single-center, superiority trial in patients undergoing DIEP flap breast reconstruction with 1-week follow-up. Randomized participants were 60 adults (projection method, n = 33; Doppler method, n = 27) undergoing DIEP flap breast reconstruction without lymph node transfer.

Results: Sixty patients provided 69 DIEP flaps for analysis. The projection method is capable preoperatively of displaying significantly more perforators compared to the Doppler method (61.7 ± 7.3 percent versus 41.2 ± 8.2 percent, respectively; p = 0.020)). During the procedure, flap harvest time is decreased by 19 minutes (136 ± 7 minutes versus 155 ± 7 minutes; p = 0.012). Complications were comparable across both groups.

Conclusion: Not only can more perforators be identified intraoperatively using the projection method compared with Doppler ultrasound, there is also a significant time reduction in harvesting the DIEP flap.


Nijmegen, The Netherlands

From the Department of Plastic Surgery and the Department of Radiology, Section of Interventional Radiology, Radboud University Medical Center.

Received for publication May 22, 2018; accepted October 19, 2018.

This trial is registered under the name “Advanced Planning of DIEP Flap Patients,” Dutch Trial Register identification number NTR5962 (

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Stefan Hummelink, Ph.D., Department of Plastic Surgery (hp 634), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands,

Copyright © 2019 by the American Society of Plastic Surgeons