Reliability of Color Doppler Ultrasound Imaging for the Assessment of Anterolateral Thigh Flap Perforators: A Prospective Study of 30 Perforators

Debelmas, Alexandre; Camuzard, Olivier; Aguilar, Paola; Qassemyar, Q.

doi:10.1097/prs.0000000000004117

Cited by 40 publications

(31 citation statements)

References 11 publications

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“…17 CCDS has quickly gained momentum and seems to spread faster than other diagnostic modalities for perforator evaluation. 2,10,14,25,[27][28][29] Kehrer et al demonstrated that sensitivity of CCDS was 96.7% with an average distance from the true projection of EP to the CCDS skin marking of 2.45 AE 1.90 mm (range: 0-6 mm). 19 All perforators detected by CCDS and confirmed intraoperatively were sizable (!…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction

Kehrer

Heidekrueger

Lonic

et al. 2020

J Reconstr Microsurg

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Background Preoperative ultrasound (US)-guided perforator mapping has immensely simplified perforator flap planning. It may be executed by the microsurgeon. Device settings and selection of ultrasound modes are of utmost significance for detection of low-flow microvessels. The following study evaluates different US modes. Methods A prospective complete data acquisition was performed from July 2018 to June 2019 in a subset of patients who underwent US-guided flap planning. Multifrequency linear transducers were used applying five US modes. Brightness (B)-mode, color flow (CF), power Doppler (PD), pulse wave (PW), and B-flow modes were evaluated regarding applicability by microsurgeons. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were chosen to evaluate flow characteristics. US results were correlated to intraoperative findings. Results A total number of eight patients (six males and two females) undergoing anterolateral thigh (ALT) or superficial circumflex iliac artery perforator (SCIP) flap surgery received an extensive standardized US-guided perforator characterization. Qualitative evaluation was performed in B-mode, color-coded duplex sonography (CCDS), PD, and B-flow mode. Quantitative assessment was executed using PW-mode and CCDS measuring the microvessels' diameter (mm) and flow characteristics (PSV, EDV, and RI). CCDS provided a mean diameter of 1.93 mm (range: 1.2–2.8 ± 0.51), a mean systolic peak of 16.9 cm/s (range: 9.9–33.4 ± 7.79), and mean RI of 0.71 (range: 0.55–0.87 ± 0.09) for lower limb perforators. All perforators located with US were verified by intraoperative findings. An optimized, time-effective US mapping algorithm was derived. Qualitative parameters may be evaluated with B-mode, CF, or B-flow. Smallest microvessels may be assessed in PD-mode. Lowering pulse-repetition frequency (PRF)/scale is mandatory to image low-flow microvessels as perforators. Quantitative information may be obtained using PW-mode and the distance-measuring tool in CF-mode. Image and video materials are provided. Conclusion CCDS proved to be a powerful tool for preoperative perforator characterization when using a structured approach and mapping algorithm. Different techniques may be applied for specific visualizations and performed by the microsurgeon.

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Section: Discussionmentioning

confidence: 99%

High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction

Kehrer

Heidekrueger

Lonic

et al. 2020

J Reconstr Microsurg

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“…Regarding color Doppler, its advantages lie on the wide availability of the exam; on expert hands is quick to perform; it does not involve radiation or the use of contrast and provides hemodynamic information of the vessels, being able to detect the anchoring point to the dermis, thus facilitating the harvesting of thin and ultrathin flaps. 28 On the other hand, its disadvantages are the ability to detect only vessels larger than 0.5 mm, does not provide a three-dimensional (3D) description of the anatomy, to be an operator-dependent test, and it is not easy to perform and to interpret. 29,30 CTA advantages are its ability to capture vessels of smaller caliber than ultrasound, larger than 0.3 mm.…”

Section: Discussionmentioning

confidence: 99%

A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap

Pereira

Parada

Kufeke

et al. 2019

J reconstr Microsurg

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Background The superficial circumflex iliac artery perforator flap (SCIP) is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. Different planning methods have been described, but these are not yet standardized like in other flaps. The aim of this study is to present a fast, effective, and reliable method for SCIP flap planning using computed tomography angiography (CTA). Patients and Methods Between October 2017 and September 2018, CTA was performed on 40 patients. Preoperative planning of SCIP flaps based on the medial branch was performed analyzing CTA images. The perforating sites of the medial branch on the deep (point D) and superficial fascia (point S) were identified. Distances to those points, from the center of the umbilicus in the “y-axis” and the midline perpendicularly in the “x-axis,” were measured. These measurements were transferred to the patient's skin as a guide for dissection. Results Eighty areas were studied identifying points D and S in CTA. Forty-three SCIP flaps were performed using this planning method. In 100% of the flaps, points D and S matched perfectly with handheld Doppler and surgical findings. Conclusion Points D and S method for medial branch based SCIP planning with CTA is an easy to learn, efficient, fast, and reliable technique for preoperative planning, allowing a safe and predictable elevation of the flap.

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“…Thus, all surgeons need to be proactive about preventing flap ischemia in their surgical planning. Using other medical equipment can help mitigate flap ischaemia-i.e., doppler ultrasound [7], CT angiogram [8,9], and magnetic resonance angiography [10]; by helping to determine the location of vessels supplying the Jenwitheesuk/Mahakkanukrauh/Punjaruk/Jenwitheesuk/Surakunprapha/Punyavong/Winaikosol/Chowchuen/ Limrattanapimpa lesion when it is uncertain whether the vessels were damaged after trauma.…”

Section: Discussionmentioning

confidence: 99%

Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series

Jenwitheesuk¹,

Mahakkanukrauh²,

Punjaruk³

et al. 2018

biomedicalresearch

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Reliability of Color Doppler Ultrasound Imaging for the Assessment of Anterolateral Thigh Flap Perforators: A Prospective Study of 30 Perforators

Abstract: Diagnostic, II.

Cited by 40 publications

References 11 publications

High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction

High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction

A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap

Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series

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