Computed Tomography-Ultrasound Fusion for Perforator Mapping before Deep Inferior Epigastric Artery Flap Breast Reconstruction

The deep inferior epigastric artery perforator flap is the gold standard for autologous breast reconstruction. However, anatomical variability of the abdominal perforators poses significant challenges for microsurgical planning. Both computed tomography (CT) angiography and Doppler ultrasound (US) can be used for pre-surgical planning. Each method has inherent advantages and disadvantages. In this technical note, we describe how CT-US fusion can be leveraged as a navigation tool for efficient perforator mapping by combining the high-resolution anatomic detail of CT angiography and the real-time nature of Doppler US. The technique is especially helpful for mapping small, significant perforators and the intramuscular course.