A comparative study of preoperative color‐coded Duplex ultrasonography versus handheld audible Dopplers in ALT flap planning

Abstract

IntroductionThe anterior lateral thigh (ALT) flap's vascular variability can lead to complications. Thus, the accuracy of numerous planning modalities has been studied. The clinical relevance of competing mapping methods, however, remains unknown. Therefore, we compared the impact of color‐coded Duplex ultrasonography and handheld audible Dopplers on surgical efficacy and flap safety.Patients and methodsForty‐four ALT flaps were included in this comparative retrospective monocentric study. Twelve patients received Duplex scans and 32 flaps were designed using Dopplers only. Patient, defect, and flap characteristics of both groups were analyzed. The effect of either planning method on the primary outcome variables – flap harvest and operative times (HT, OT), course of perforator dissection, incidence of flap loss, emergent re‐explorations, and donor‐site revisions – was then assessed.ResultsPatient, defect, and flap characteristics were comparable between both groups, including flap size (Doppler: 134 ± 73 cm2, Duplex: 131 ± 65 cm2, p = .90). There was no flap loss. Emergent re‐explorations (Doppler: 4/32, Duplex: 1/12, p = .70) and donor‐site revisions (Doppler: 2/32, Duplex: 1/12, p = .81) were equally distributed. Duplex rendered septal perforator dissection 10 times more likely (Chi‐Square = 8.9, p = .003, OR = 9.7), reaching 50% (n = 6/12), as opposed to only 9% in the Doppler cohort (n = 3/32). This allowed for highly significant HT and OT reductions of 89 minutes, respectively (p < .01): from 255 and 383 min (Doppler) to 166 and 294 min (Duplex).ConclusionsPreoperative Duplex significantly reduces harvest and operative times of ALT flaps.

Feasibility study of preoperative microvessel evaluation and characterization in perforator flaps using various modes of color‐coded duplex sonography (CCDS)

“…(Cheng, Lin, & Chang, 2012a, 2012b. Thomas et al (2020) confirmed the superiority of CCDS to conventional Doppler US for perforator mapping and characterization prior to ALT flap harvest. Kehrer et al showed that sensitivity of PD for microvessel detection was 96.7% with a mean distance from the emergence point (true anatomy) to the projected preoperative skin marking after PD mapping (assumed anatomy) of 2.45 ± 1.90 mm (0-6 mm) (Kehrer, Hsu, Chen, Sachanandani, & Tsao, 2018).…”

“…A systematic review by Cheng et al comparing hand‐held Doppler, CCDS, and CT angiography revealed that CCDS had the highest pooled sensitivity of 95.7% as well as the highest pooled positive predictive value of 94.3% to identify microvessels for perforator flaps such as the ALT flap (Cheng, Lin, & Chang, 2012a, 2012b, 2013). Thomas et al (2020) confirmed the superiority of CCDS to conventional Doppler US for perforator mapping and characterization prior to ALT flap harvest. Kehrer et al showed that sensitivity of PD for microvessel detection was 96.7% with a mean distance from the emergence point (true anatomy) to the projected preoperative skin marking after PD mapping (assumed anatomy) of 2.45 ± 1.90 mm (0–6 mm) (Kehrer, Hsu, Chen, Sachanandani, & Tsao, 2018).…”

“…Comparable results were reported by Thomas et al, who proved the time and cost efficiency of CCDS over conventional Doppler sonography due to perforator mapping preoperatively. They reported a reduction of about 73 min in harvesting time and of up to 90 min in operating time if CCDS guided perforator assessment was performed preoperatively (Thomas et al, 2020). This circumstance may not be underestimated as a combination of different reconstructive steps may help to save hospitalization time, costs and resources.…”

“…Furthermore, CCDS examinations are free of radiation exposure and are not dependent on contrast media. Overall availability, time, and cost savings are other important advantages of this fast‐growing technology (Hayashi et al, 2019; Thomas et al, 2020; Visconti, Bianchi, Hayashi, & Salgarello, 2019; Visconti, Hayashi, Bianchi, & Salgarello, 2019).…”

A single‐center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times

“…In line with this, we recently conducted an analysis of 44 ALT free flaps for distal upper extremity reconstruction with regard to the potential benefits and clinical relevance of preoperative color-coded Duplex ultrasonography ("Duplex") in comparison to handheld Doppler devices ("Doppler") (Thomas et al, 2020). Although we were able to show that Duplex significantly reduced both operative and harvest times of ALT free flaps in this select cohort of patients, the generalizability of our observations remains yet to be proven.…”