Designing An Anterolateral Thigh Flap Using Ultrasound

Abstract

Background Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. Methods In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. Results Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. Conclusion Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.

Planes for Perforator/Skin Flap Elevation—Definition, Classification, and Techniques

“…This may be the current ideal modality to map the distinctive planes of potential elevation as well as the vascular pathway in the same position as if in surgery. 25,[31][32][33][34] There was a 100% correlation between the preoperative perforator mapping using duplex color ultrasonography and intraoperative findings. 22 In addition to the vascular pathway and vessel diameter, peak velocity and flow volume can be calculated to evaluate the physiologic aspect of the proposed flap.…”

A Safer Way to Harvest a Superthin Perforator Flap

“…1), we look for a type 1 perforator with ultrasound in both thighs, whereas if we plan to harvest a thin perforator anterolateral thigh flap (along the Scarpa fascia), we look for a type 2 perforator. 4,5 The ultrasound gives the further advantages of precise measurement of flap thickness, seeing the entire course of the perforator (septocutaneous versus musculocutaneous), and thus anticipating the entire dissection preoperatively. In our experience, ultrasound preoperative planning should be considered a quintessential approach, especially in thin perforator flap elevation.…”

“…In the last 5 years, further advances have been made regarding the method of thin flap elevation based on ultrasound technology. 4,5 Preoperative planning of the perforator flap using ultrasound technology (either high frequency or ultra-high frequency, especially for superthin and pure-skin perforator flaps) allows the operating surgeon to anticipate the very superficial microvascular anatomy, giving the operating microsurgeon all the information required for a safer and faster elevation of any kind of thin flap following its peculiar subcutaneous anatomy.…”

“…1), we look for a type 1 perforator with ultrasound in both thighs, whereas if we plan to harvest a thin perforator anterolateral thigh flap (along the Scarpa fascia), we look for a type 2 perforator. 4,5…”

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

“…5,6 Achieving split-skin paddle flaps relies heavily on available multiple perforators, which were often unpredictable despite preoperative Doppler exploration or computed tomography angiography planning. [7][8][9][10][11] Unfortunately, a considerable amount of anterolateral thigh flaps possesses single perforator or even with absent or unreliably small perforators, rendering the resultant flap "unsplittable." 12 The authors were inspired by the prior success of harvesting thin-layered "capillary nonsizable perforators" in flaps lacking sizable perforators to overcome this predicament.…”