Deep inferior epigastric artery perforator (DIEP) flaps are widely regarded as the gold standard for autologous breast reconstruction due to their ability to provide excellent cosmetic outcomes while preserving muscle function. However, the surgical technique presents a significant learning curve and often requires longer operating times, primarily because of the complexities involved in identifying suitable perforators during surgery. Locating these perforators is traditionally done using Doppler ultrasound, but this process can be both time-consuming and technically challenging, especially for operators with limited experience.
To address these challenges and optimize both surgical efficiency and outcomes, our institution has adopted a protocol of performing preoperative skin marking using ultrasound in advance of the surgery. This process takes place in the Breast Radiology department, where radiologists use ultrasound to accurately locate the most suitable perforators. The perforator locations are then marked on the patient’s skin, ensuring that the surgical team can quickly and efficiently access these critical points during the actual operation. This technique not only reduces the time required in the operating room but also enhances the precision of the flap harvest, which can lead to improved outcomes for patients.
Our experience with preoperative ultrasound-guided skin marking has been overwhelmingly positive. It has led to more streamlined operations, reduced intraoperative decision-making time, and minimized the stress associated with perforator localization. Additionally, by performing this critical step in advance, we have been able to better manage our operating theatre schedules, thereby improving overall efficiency. This approach serves as an effective strategy for mitigating the inherent challenges of DIEP flap surgery, ultimately contributing to better patient care and outcomes.
