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Determining Extent of Perfusion Per Given Perforator: Defining The Perforasome
Jason Cacioppo, MD
Adam Cohen, MD
Andrew Swearingen, MD
Indiana University Plastic Surgery
2012-02-14
Presenter: Jason Cacioppo
Affidavit:
Director Name: J Coleman
Author Category: Attending
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
How does this presentation meet the established conference educational objectives?
This presentation addresses the question: What factors are important in determining perforator flap perfusion? The information presented will enhance flap outcomes and help to minimize complications such as fat necrosis and partial flap necrosis.
How will your presentation be used by practicing physicians in the audience?
The results of this study should aid the plastic surgeon in better understanding the diep flap and perforator flap physiology. This should help the surgeon design a more effective and predictable flap for a given patient.
A Perforasome is defined as the volume of tissue perfused by a given perforator. Determining the exact boundaries of the perforasome is done to some extent in nearly every perforator flap and is usually based on the surgeon's analysis of perfusion. We sought to employ a more objective measurement of perfusion using tissue oximetry to more extensively assess the perforasome limits.
Nineteen DIEP flaps were elevated in-vivo on a single perforator in 19 women undergoing post-mastectomy breast reconstruction. The perfusion of the entire flap was then assessed at multiple points and quantified with tissue oximetry. Variables such as perforator size, flap thickness and extent of perfusion were then analyzed.
Perforator size was a determining factor in the size of the perforasome and was a statistically significant predictor. Flap thickness was not a significant determinator.
DIEP perforasomes vary among patients. Perforator size seems to be a determinant and perhaps the most important in setting the limits of perfusion. Future study of these factors and their degree of influence should be examined in the hopes of developing a system to accurately determine the perforasome extent pre-operatively for a given patient.
