{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:39:48Z","timestamp":1791639588386,"version":"4.3.4"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Deep inferior epigastric artery flaps (DIEP) represent the gold standard of autologous breast reconstruction. Due to significant variations in vascular anatomy, preoperative perforator mapping (PM) is mandatory in order to ensure the presence of a sufficient perforator within the flap. In this regard, CT angiography (CTA) is currently the method of choice. Therefore, we investigated the value of contrast-enhanced ultrasound (CEUS) techniques for preoperative PM in comparison to CTA. Patients underwent PM, utilizing both CTA and CEUS techniques. Documentation included the course of the vascular pedicle through the rectus muscle (M), fascial penetration (F), the subcutaneous plexus (P) and the skin point (SP) on either side of the abdomen. Thus, contrast-enhanced B-Flow (BCEUS), B-Flow ultrasound (BUS), CEUS, color Doppler ultrasound (CDUS) and CTA were evaluated in terms of the diagnostic consistency and effectiveness of PM. Precision (\u2206L) was then calculated in relation to the actual intraoperative location. Statistical analysis included Kruskall\u2013Wallis, Levene and Bonferroni tests, as well as Spearman correlations. A total of 39 DIEP flaps were analyzed. Only CTA (\u2206L = 2.85 mm) and BCEUS (\u2206L = 4.57 mm) enabled complete PM, also including P and SP, whereas CDUS, CEUS and BUS enabled clear PM throughout M and F only. Regarding the number of detected perforators, PM techniques are ranked from high to low as follows: CTA, BCEUS, BUS, CEUS and CDUS. CTA and BCEUS showed sufficient diagnostic consistency for SP, P and F, while CDUS and CTA had a superior performance for M. BCEUS offers precise image-controlled surface tags and dynamic information for PM without imposing radiation and may, therefore, be considered a feasible add-on or alternative to CTA. However, BCEUS requires an experienced examiner and is more time-consuming.<\/jats:p>","DOI":"10.3390\/jpm13010064","type":"journal-article","created":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T08:38:19Z","timestamp":1672216699000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Preoperative Perforator Mapping in DIEP Flaps for Breast Reconstruction. The Impact of New Contrast-Enhanced Ultrasound Techniques"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8017-9543","authenticated-orcid":false,"given":"Max J","family":"Zinser","sequence":"first","affiliation":[{"name":"Division of Plastic-, Reconstructive- and Aesthetic Surgery, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Kr\u00f6ger","sequence":"additional","affiliation":[{"name":"Division of Plastic-, Reconstructive- and Aesthetic Surgery, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Malter","sequence":"additional","affiliation":[{"name":"Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tino","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sana-Clinic, Gr\u00e4ulinger Str. 120, 40625 D\u00fcsseldorf-Gerresheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-1653","authenticated-orcid":false,"given":"Michael","family":"Puesken","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Mallmann","sequence":"additional","affiliation":[{"name":"Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Zirk","sequence":"additional","affiliation":[{"name":"Division of Plastic-, Reconstructive- and Aesthetic Surgery, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Division of Plastic-, Reconstructive- and Aesthetic Surgery, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Andree","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sana-Clinic, Gr\u00e4ulinger Str. 120, 40625 D\u00fcsseldorf-Gerresheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Seidenstuecker","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sana-Clinic, Urdenbacher Allee 83, 40593 D\u00fcsseldorf-Benrath, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Maintz","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0207-5474","authenticated-orcid":false,"given":"Ralf","family":"Smeets","sequence":"additional","affiliation":[{"name":"Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Eichler","sequence":"additional","affiliation":[{"name":"Breast Center, St. Franziskus-Hospital, Hohenzollernring 72, 48145 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver C","family":"Thamm","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Witten-Herdecke, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Heneweer","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 32, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,28]]},"reference":[{"key":"ref_1","first-page":"423","article-title":"The free abdominoplasty flap and its use in breast reconstruction. 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