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Equation Helps Assess Blood Flow to Breast Reconstruction Flaps

Flap viability index shows critical blood flow level in DIEP technique, surgeons report

FRIDAY, Oct. 17, 2014 (HealthDay News) -- A simple formula can reliably predict whether there will be sufficient blood flow to deep inferior epigastric perforator (DIEP) flap pedicles in women undergoing breast reconstruction using the advanced DIEP technique, according to a study published online Oct. 3 in Plastic Reconstructive Surgery Global Open.

Joseph Richard Dusseldorp, M.B.B.S., and David G. Pennington, M.B.B.S., from Macquarie University in Sydney, sought to determine how well the flap viability index (FVI) equation predicted blood flow in 10 consecutive DIEP flap pedicles 24 hours after anastomosis. They report that FVI is calculated using data on the diameter of the available vessels and the weight of the final flap, with total flap survival likely at FVI over 10.

The patients had an average FVI score of 14.2. The researchers observed a strong correlation between flow rate and perforator diameter (r = 0.82; P = 0.01). The weight of the DIEP flap also correlated with the perforator diameter, although to a lesser degree. In DIEP flaps with two or more perforators, the mean arterial flow rate was significantly reduced (6 versus 38 cm³/min; P < 0.05).

"This study confirms that perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators," the authors write. "However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival."

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