Color Doppler ultrasonography targeted reconstruction using pedicled perforator flaps—a systematic review and meta-analysis

Ibrahim, Rami Mossad; Gunnarsson, Gudjon Leifur; Akram, Javed; Sørensen, Jens Ahm; Thomsen, Jørn Bo

doi:10.1007/s00238-018-1435-y

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…The TDA procedure selection can be guided by CDU, which enables the surgeon to perform the selected reconstruction as a targeted procedure by identifying all relevant perforators. This can be performed and used in the outpatient clinic prior to surgery to guide the patient to the safest TDA flap option with the least possible donor site morbidity [ 32 - 34 ]. During surgery, CDU can be used to locate the perforators and to obtain an estimate of the perforator size and topography, including anatomical variations [ 11 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

et al. 2021

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Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

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Section: Discussionmentioning

confidence: 99%

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

et al. 2021

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“…Furthermore, it is more readily available for the general plastic surgeon and is a relatively fast option for bilateral breast reconstruction in comparison with free flap reconstruction (13,23,24). CDU can be used not only to identify the perforators but can also be used as a tool in the surgical planning, drawing and dissection of the flap (5,18,25). The use of CDU may allow for faster dissection and thus decrease operating time.…”

Section: Discussionmentioning

confidence: 99%

“…It is well-known that the boundaries of the angiosomes can be a challenge (18,(25)(26)(27)(28). However, with increasing experience, the use of CDU and lately ICG, the risk of major and minor complications have diminished to a minimum.…”

Section: Discussionmentioning

confidence: 99%

Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps

Lorenzen

Gunnarsson²,

Bille

et al. 2019

Gland Surg.

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Thoracodorsal artery perforator (TAP) flaps are versatile flaps that provide a consistent and aesthetically pleasing breast reconstruction. We prefer the TAP flap to the latissimus dorsi (LD) flap due to the morbidity associated with the LD flap. In this paper we aim to show how we perform bilateral TAP flap breast reconstruction and present our preliminary results from 32 bilateral reconstructions in 16 patients. The TAP flap breast reconstruction can be performed as a direct-to-implant or a delayed procedure depending on patient factors. Color Doppler ultrasonography (CDU) is used in the preoperative planning which promotes the safety and reliability of the flap by mapping perforators thus enabling faster dissection. The bilateral TAP flap breast reconstruction is usually performed in three steps: (I) raising the flaps at the recipient site; (II) rotating the TAP flaps and (III) completion of the breast reconstruction.

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“…Color Doppler ultrasonography (CDU) was recommended by Blondeel et al [9] for planning other flaps such as the deep inferior epigastric perforator and the thoracodorsal artery perforator flap. Most recent studies have shown the reliability of CDU for detecting ALT perforators [10,11].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

Lee

Park

Roh

et al. 2021

Arch Hand Microsurg

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Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

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Color Doppler ultrasonography targeted reconstruction using pedicled perforator flaps—a systematic review and meta-analysis

Cited by 14 publications

References 26 publications

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

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