The anterolateral thigh flap has many advantages, but it has not yet achieved widespread use because the perforators exhibit considerable anatomical variation and their locations are difficult to predict preoperatively. The authors performed a prospective study to investigate whether acoustic Doppler flowmetry and color Doppler ultrasonography were helpful for preoperative localization of the perforators in anterolateral thigh flaps. Ten patients scheduled for anterolateral thigh flap surgery were examined preoperatively with both acoustic Doppler flowmetry and color Doppler ultrasonography, and all points where the perforators seemed to penetrate the fascia lata were mapped. The actual perforating points were identified intraoperatively and were compared with the preoperatively mapped points. Fifteen perforators were detected in 10 patients. The concordance rate with acoustic Doppler flowmetry was 40 percent (95 percent confidence interval, 15 to 68 percent; p = 0.05). In contrast, the concordance rate with color Doppler ultrasonography was 100 percent (95 percent confidence interval, 81 to 100 percent; p = 0.05). Color Doppler examination was significantly more accurate than acoustic Doppler examination (determined by the binomial test; p < 0.0014). Three-dimensional anatomical information around the perforators was further useful in elevating flaps. The authors conclude that color Doppler examination can accurately identify the perforators and is useful for planning in anterolateral thigh flap surgery, whereas acoustic Doppler examination is unreliable.
Pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps have been generally used for bilataral breast losses. The major disadvantages of this method are the total or subtotal loss of the rectus abdominis muscles and various resulting postoperative complications, such as abdominal bulging and lumbar pain. With the recent development of perforator flaps and supermicrosurgery with anastomosis of 0.5-mm caliber vessels, these serious complications can be overcome with a paraumbilical perforator adiposal flap with only perforators without the deep inferior epigastric artery and the rectus abdominis muscle. This article describes the successful use of paraumbilical adiposal flap for patients with breast loss and facial contour deformities without secondary debulking for recontouring. The advantages of this method are one-stage augmentation with minimal donor site morbidity resulting in minimum invasive surgery with minimum incision. KEYWORDS: Paraumbilical perforator flap, supermicrosurgery, pedicled rectus abdominis myocutaneous flap, deep inferior epigastric perforator flap Downloaded by: University of Queensland. Copyrighted material.
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