Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model

Christiansen, J.; Leong‐Poi, Howard; Amiss, L. R.; Drake, David B.; Kaul, Sanjiv; Lindner, Jonathan R.

doi:10.1016/s0301-5629(01)00523-3

Cited by 19 publications

(10 citation statements)

References 12 publications

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“…The post-operative control of microvascular flaps is extremely demanding for imaging [1][2][3][4][5][6][7][8][9][10][11][12]. It is crucial to evaluate the flow ratio of the vessels feeding the flaps and the perfusion of the different layers of the graft, to detect deficits in perfusion as early as possible [9,[24][25][26].…”

Section: Discussionmentioning

confidence: 99%

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New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography

Jung

Prantl

Schreyer

et al. 2009

Clinical Hemorheology and Microcirculation

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Purpose: Evaluation of post-surgery tissue perfusion of free flaps of the lower leg with contrast enhanced harmonic imaging (CHI), laser-induced indocyanine green (ICG) fluorescence angiography and magnetic resonance imaging (MRI).Materials and methods: 10 patients with free flaps of the lower limb were evaluated with CHI, ICG-fluorescence angiography and perfusion weighted MRI. Perfusion weighted MRI was performed after intravenous bolus injection of 25 ml Gd-DTPA. The ICG fluorescence was detected by a near-infrared-laser device (λem = 780 nm). Ultrasound was carried out by an experienced examiner with a linear probe after intravenous bolus injection of 2.4 ml SonoVue ® . For MRI time intensity curves as well as color-coded blood volume maps of the whole free flap were qualitatively evaluated. For CHI and ICG time intensity curves in selected regions of interest were analyzed. A score from 1-5 (1 = low, 5 = excellent) was used for analysis of perfusion images by three independent readers.Results: In 3 cases (radialis, parascapular and lateral thigh flap) CHI, MRI and ICG perfusion imaging showed an excellent (score 4-5) contrast enhancement of the cutaneous and subcutaneous part of the free flaps. In 2 cases of osteocutaneous flaps perfusion in central and distal parts of the free flaps was reduced (score 2). Correlation between CHI, MRI and ICG was 0.69-0.83 for the distal parts of the free flaps and 0.74-0.87 for the center of the flaps (Spearman test). Perfusion in the center of the free flaps was significantly different for MRI and ICG and also for MRI and CHI (p < 0.05, Wilcoxon test).Conclusion: These first results introduce CHI and MRI perfusion imaging as a promising post-surgery monitoring in patients with free flaps.

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Section: Discussionmentioning

confidence: 99%

“…Currently there is no image-guided modality which is sufficient and exact enough to evaluate the perfusion of tissue in its different layers after transplantation of microvascular flaps [1][2][3][4][5][6][7][8][9][10][11][12]. Examination of capillary filling after compression (refill) allows merely a vague estimation.…”

Section: Introductionmentioning

confidence: 99%

New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography

Jung

Prantl

Schreyer

et al. 2009

Clinical Hemorheology and Microcirculation

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“…Overall, perfusion studies with microbubble contrast are now routinely used in the clinical setting worldwide (except USA as of now); they can provide blood flux information in the settings where Doppler imaging is not useful due to smallest size of the vessels in the tissue (e.g., in a transplanted skin flap [115]). An unfortunate limitation of this technique is in the inability of ultrasound at imaging frequencies to transit through the human skull without attenuation; thus, brain perfusion studies that are routinely performed with functional MRI cannot be performed with contrast ultrasound unless there is a burr hole present [116].…”

Section: Destruction-replenishment As a Tool For Perfusion Contrast Imentioning

confidence: 99%

Ultrasound in Radiology

Klibanov

Hossack²

2015

Investigative Radiology

101

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During the past decade, ultrasound has expanded medical imaging well beyond the “traditional” radiology setting - a combination of portability, low cost and ease of use makes ultrasound imaging an indispensable tool for radiologists as well as for other medical professionals who need to obtain imaging diagnosis or guide a therapeutic intervention quickly and efficiently. Ultrasound combines excellent ability for deep penetration into soft tissues with very good spatial resolution, with only a few exceptions (i.e. those involving overlying bone or gas). Real-time imaging (up to hundreds and thousands frames per second) enables guidance of therapeutic procedures and biopsies; characterization of the mechanical properties of the tissues greatly aids with the accuracy of the procedures. The ability of ultrasound to deposit energy locally brings about the potential for localized intervention encompassing: tissue ablation, enhancing penetration through the natural barriers to drug delivery in the body and triggering drug release from carrier micro- and nanoparticles. The use of microbubble contrast agents brings the ability to monitor and quantify tissue perfusion, and microbubble targeting with ligand-decorated microbubbles brings the ability to obtain molecular biomarker information, i.e., ultrasound molecular imaging. Overall, ultrasound has become the most widely used imaging modality in modern medicine; it will continue to grow and expand.

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“…An exact assessment of flap viabilityespecially in the first days after the operation [8] -is therefore of great interest in many fields of medicine. Several different monitoring systems have been developed over the last years [5,7,[9][10][11][12] but none of them has made its way into clinical routine. Due to this fact, clinical examination by the surgeon remains the "gold standard" for skin graft evaluation.…”

Section: S Geis Et Al / Evaluation Of Free Skin Flap Viability Usinmentioning

confidence: 99%

Postoperative assessment of free skin flap viability by transcutaneous pO2 measurement using dynamic phosphorescence imaging

Geis

Schreml

Lamby

et al. 2009

Clinical Hemorheology and Microcirculation

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Background: Free flap transplantation is used more and more frequently in order to cover extensive wound defects. The basic prerequisite for successful flap salvage after flap failure is a short time interval from failure until revision. For this reason many different flap monitoring systems have been tested over the last years. But none of them has made the way into clinical routine.Objective: The aim of this clinical study was to study whether luminescence lifetime imaging (LLI) is an adequate method to assess flap viability during the postoperative period. In previous experiments LLI was proven to be a precise and non-invasive monitoring system for transcutaneous oxygen measurement.Methods: ptcO 2 of 9 patients was detected during a postoperative period of 72 hours. In all cases the transplantation was performed by the same experienced surgeon. During the first 4 hours almost constant ptcO 2 values were detected (53 ± 0.7 mmHg). During the following time intervals ptcO 2 values decreased and reached a more or less constant level after approximately 12 hours. The mean ptcO 2 decreased from 53 ± 0.7 mmHg to 39 ± 1.0 mmHg. In one case an immediate decrease of ptcO 2 below 10 mmHg was observed and a subsequently intervention was necessary to improve flap perfusion.Conclusion: In this clinical trial, perfusion dynamics after free flap transplantation as well as the detection of vascular complications were demonstrated using LLI. Based on these data, LLI seems to be a sensitive and adequate monitoring system for the evaluation of free flap viability.

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Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model

Cited by 19 publications

References 12 publications

New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography

New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography

Ultrasound in Radiology

Postoperative assessment of free skin flap viability by transcutaneous pO2 measurement using dynamic phosphorescence imaging

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