Portable Color-Flow Ultrasound Facilitates Precision Flap Planning and Perforator Selection in Reconstructive Plastic Surgery

Abstract

Background Precise flap planning and perforator selection are paramount for successful perforator flap surgery. Portable color-flow ultrasound (PCFU) is a convenient, low-cost, easily accessible imaging modality that is pivotal in the planning of perforator flaps where anatomic variability is the rule. Methods Perforator mapping was performed using an L12–4 linear-array ultrasound probe connected to an Android tablet. Images were obtained with the Lumify app (Philips Lumify, usa.philips.com). Perforator characteristics were recorded (arterial diameter, emergence points from fascia, subcutaneous course, and projection onto the skin surface) using still images and real-time videos. Results Thirty consecutive patients had 40 perforator or musculocutaneous flap reconstructions over a 2-year period. For the 15 flaps that had preoperative computed tomographic angiography (CTA) imaging, the preoperative sonographic measurements correlated with CTA and intraoperative findings. Portable color-flow ultrasound allowed perforator flap design and selection based on the largest available perforator, the most appropriate flap thickness, and comparison of multiple donor sites including left versus right. Two deep inferior epigastric perforator patients required take-back to the operating room for debridement of devitalized nonflap tissue. The superior gluteal artery perforator flap was abandoned intraoperatively due to proximal vascular anomalies. Overall flap success rate was 98% (39/40 flaps). Conclusions Our experience with PCFU has rapidly improved, allowing individualized perforator flap selection and design based on each patient's unique perforator anatomy, reconstructive requirements, and donor site characteristics. In our practice, PCFU has supplemented CTA and in many cases has supplanted CTA as the primary imaging modality of choice in the planning of perforator flap reconstruction.

Comparison of Various Modalities Utilized for Preoperative Planning in Microsurgical Reconstructive Surgery

“…59 Although widespread adoption of ultrasound has historically been slow due to lack of familiarity and specialized training, more recent studies have shown that a working knowledge of the newer duplex ultrasound devices can be achieved in a relatively short amount of time. 9 59 103 The consummate masters of human anatomy, plastic, and reconstructive surgeons are uniquely poised to flourish using ultrasound technology.…”

Versatile clinical application of radial artery perforator flap for hand and wrist reconstruction

“…Although a preoperative Allen test is not necessary since flap circulation is independent of ulnar-radial palmar vascular communication, patency of the radial artery at the site of septocutaneous perforators branching is crucial for flap survival. Doppler ultrasound examination was performed in all patients to identify and to map the arterial perforators which can be aggravated by the dominant sound of the superficially placed radial artery at the level of the distal forearm 10 .…”

How to Design and Harvest a Propeller Flap

“…13 Some drawbacks slowly being overcome include the greater cost, lack of portability, and technical difficulties when in use. 14,15 Thermography has become a complementary method using thermal cameras to measure skin temperature, where hot spots correspond to the location of perforators. 16,17 As also a topic included in this issue using smartphones, this is now affordable and easily obtainable for propeller flap planning, intraoperative decision-making, and postoperative monitoring.…”