Color Doppler flow mapping of abdominal wall perforating arteries for transverse rectus abdominis myocutaneous flap in breast reconstruction: Method and preliminary results

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.