The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap

Abstract

The anterolateral thigh (ALT) flap has become a workhorse in reconstructive surgery of the head and neck region and the extremities. However, its inconsistent vascular anatomy and frequent intramuscular course of perforators often cause difficulties during the dissection of this versatile flap. Hence, reliable preoperative perforator mapping and identification of vascular anomalies may render the raising of the flap easier and safer. The aim of this study was to evaluate the use of Color Duplex sonography and whether it allows the distinction between septocutaneous and musculocutaneous perforators. For this purpose, the thighs of 13 patients undergoing reconstruction with ALT flaps were examined preoperatively, and results were compared to intraoperative findings. A total of 30 perforators could be detected preoperatively, of which 29 were confirmed during flap dissection. Preoperative Color Duplex sonography correctly predicted the course of all perforators as either running through the vastus lateralis muscle or the intermuscular septum. In our investigations, Color Doppler sonography had a 96.7% positive predictive value and a 96.7% true positive rate in detecting perforators. Color Duplex sonography is a highly reliable tool in the preoperative assessment of ALT flaps. Localization and course of perforators can be determined accurately and vascular anomalies can be identified.

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

“…Data obtained in our study confirms that CDU is highly sensitive, over 93%, when used for preoperative perforator mapping. These findings correlate well with other published data [26,27], showing the high level of reproducibility among various studies.…”

The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get

“…Literature on the validity of the Doppler for detecting perforators has shown variable results. Giunta et al and Ensat et al found positive predictive value rates of 52% and 69%, respectively [12,13]. Two other studies reported higher positive predictive value rates varying from 82 to 94% [14,16].…”

“…So far the Doppler device has only been studied for its validity, which means that a positive signal indicates the presence of a perforator [10][11][12][13][14][15][16][17]. The presented validity properties of the Doppler device differ considerably across studies [10][11][12][13][14][15][16][17].…”

“…The presented validity properties of the Doppler device differ considerably across studies [10][11][12][13][14][15][16][17].…”

Perforator flaps: the next step in the reconstructive ladder?

“…To speed up raising the flap and facilitate planning of the initial skin incision with which to expose the perforator, techniques such as computed tomography (CT) or magnetic resonance (MR) angiography (Habib A, et al The role of preoperative perforator mapping using CT angiography compared with conventional Doppler in the successful harvest of antero-lateral thigh flaps: a comparative prospective study. Paper presented at the annual meeting of the British Association of Oral and Maxillofacial Surgeons, 2011), 22,23 near infrared spectroscopy 24 or colourcoded Duplex sonography 25 have been suggested. These methods have been proved to detect perforators in at least 95% of cases.…”