Colour Doppler Assessment of the Perforators of Anterolateral Thigh Flap and its Usefulness in Preoperative Planning

Abstract

The role of the anterolateral thigh flap (ALTF) in reconstructive microsurgery grows systematically from mid-eighties of the twenty century until now. Significant anatomic variability of the perforators supplying the ALTF was described in literature. the aim of the study was ultrasonographic assessment of the ALTF perforators in terms of localization, symmetry, diameter and flow velocity. material and methods. The study was performed using ultrasound machine with 12 MHz linear transducer. Both thighs of 30 healthy volunteers (15 men and 15 women) aged from 18 to 60 (mean 37.9) were examined. The line from anterior superior iliac spine (ASIS) to lateral border of the patella was traced, and divided into 10 equal segments. Point where perforator pierces the deep fascia was marked and its diameter was measured and recorded. Maximal flow velocity was measured and recorded. Symmetry of perforator location was confirmed as positive if difference in position of two perforators on both thighs was less than 1.5 cm in diameter. Results. Total number of 119 perforators supplying skin of 60 thighs was found (mean 1.98 perforator per thigh). No perforators were found in 4 thighs (6.6%). Perforators were most abundant in segments from 5 to 7 (74.6%). Perforators with largest diameters and maximal flow velocity reaching 30-47 cm/s were localized in segments 5 and 6. Perforators in segments 4 and 5 were more abundant in men (50.9%) than in women (36.7%). Septal perforators make up to 26.9% of the total. Eighty percent of the septal perforators were localized in segments 5 and 6. Perforator distribution was elicited in the middle of the ASIS -patella line. In the range of ±1.5 cm from the midpoint of the line 33.6% of the perforators were found. conclusions. 1. Most of perforators with large diameter and big flow velocity are located in segments 5 and 6. 2. Perforators are more common in men in segments 4 and 5 than in women. 3. No perforators found in 4 thighs suggests that preoperative perforator mapping should become a preoperative routine, which can spare intraoperative dilemmas. key words: anterolateral thigh flap, color Doppler assessment, preoperative planning * Study performed within the framework of statutory work of

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

“…Therefore, another novelty of this study was to describe reproducible and comparable flow parameters of perforator vessels, which has not been focus of other author groups before. Ulatowski (2012) presented quantitative blood flow parameters of perforators in their study, but missed out describing the basic settings and the use of an angle correction. Therefore, we figured that reproducibility and comparability were not sufficiently given.…”

Color duplex ultrasonography versus handheld Doppler to plan anterior lateral thigh flaps

“…However, the value of HD is debatable because of its low accuracy and false‐positive findings. CDU has become more popular as a scanning tool because of its growing availability, improved resolution, and low cost (Golusiński et al, ; Tsukino et al, ; Ulatowski, ; Zhou et al, ). In contrast to HD, CDU provides information regarding the vessel course, flow, and diameter.…”

Anatomical Origins of Radial Artery Perforators Evaluated Using Color Doppler Ultrasonography

“…17 Thereafter, technological improvements in color Doppler US imaging using higher frequency transducers have permitted clinical scanning to superficial depths with high sensitivity for the detection of low flow in vessels with diameter as small as 0.2 mm. As the use of Doppler US has been widely reported for the identification of perforators in the trunk and extremities with variable success, [17][18][19][20][21][22][23][24] it is now considered to have potential utility for flap planning. To the best of our knowledge, this is the first study to evaluate RAP in detail using color Doppler US.…”