High-frequency Ultrasound Evaluation of Midline Crossing-over Vessel: Correlation with Perfusion of Deep Inferior Epigastric Perforator Flap.

Abstract

The deep inferior epigastric perforator (DIEP) flap is widely used in autologous breast reconstruction, with its success heavily reliant on the vascular anatomy, particularly midline crossing-over vessels that facilitate contralateral flap perfusion. High-frequency ultrasound (HFUS) offers a non-invasive, radiation-free method to visualize small vessels and assess real-time blood flow. This study evaluates the utility of HFUS in detecting midline crossing-over vessels and their correlation with perfusion in DIEP flaps used for unilateral breast reconstruction. A prospective study was conducted on 30 women undergoing unilateral DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative HFUS was performed to assess the number, type, and diameter of midline crossing-over vessels. Intraoperative flap perfusion was quantified using indocyanine green (ICG) angiography, measuring the ICG-stained area (%). Spearman's rank correlation and multiple linear regression were used to analyze the relationship between HFUS findings and ICG area. HFUS identified midline crossing-over vessels in all patients but showed no significant correlation with ICG perfusion area (rho = -0.111, p = 0.5576). Multiple linear regression confirmed that HFUS-derived variables (vessel number, arterial presence, diameter) did not predict ICG area (R² = 0.061, p = 0.6416). HFUS provides detailed anatomical insights into midline crossing-over vessels but lacks correlation with flap perfusion, limiting its predictive value for DIEP flap outcomes. Further studies are needed to explore its association with perfusion-related complications.