Color-flow duplex scanning in the preoperative assessment of TRAM flap perforators: a report of 32 consecutive patients

This is a report of the results of preoperative color-flow duplex Doppler scanning in the assessment of TRAM flap perforators in 32 consecutive patients. A total of 190 perforators were detected with peak systolic flow velocities ranging from 8 to 81 cm/s. Perforator locations were tabulated according to their vertical position relative to the umbilicus and their lateral location relative to the abdominal midline. The periumbilical region (zones I to III) contained 80.5 percent of the perforators. Asymmetry between the two sides was detected in the majority of patients when perforator positions were evaluated laterally from the midline. The total flap survival rate within the series was 97.9 percent (46 to 47). The present study proposes that the preoperative color-flow Doppler localization of TRAM flap perforators improves the surgeon's ability to design and elevate the flap in order to capture the dominant vessels and maximize survival. In addition, preoperative knowledge of the number and flow velocity characteristics of the perforators allows for the selection of single- and double-pedicle and free TRAM flaps based on each patient's individual perfusion characteristics.