Application of high-frequency color ultrasound in preoperative identification and selection of perforator for anterolateral thigh flap grafts

Abstract

Abstract: PURPOSE: To explore the accuracy of selecting appropriate perforator vessels according to the results of preoperative high-frequency color Doppler ultrasound and guide anterolateral thing (ALT) flap harvest. METHODS: From March 2013 to December 2013, fifty-two patients underwent preoperative ultrasound before ALT harvest for head and neck cancer reconstruction. Ultrasonography was used to predict the number, origin, course, location, diameter and hemodynamics of perforators in order to choose the better donor site for flap harvest. The preoperatively mapped perforators were compared with the actual intraoperative findings. Chi-square test was carried out for comparison between preoperative and intraoperative results using SAS 9.2 software package. RESULTS: A total of 208 perforators were found by preoperative ultrasound in 52 patients. Finally 27 patients underwent ALT reconstruction for head and neck defects. There were no significant difference between preoperative and real situation of intraoperative perforator indicators (P>0.05).CONCLUSIONS: Preoperative mapping of perforators by ultrasound proved valuable in ALT flap design and harvest. The basis for ALT graft is as follows: ① perforator diameter is the first factor to be considered;②priority to the septum or half septum perforator which is easily dissected;③ select the perforator with high flow velocity and low resistance index;④ the pedicle length of perforator meets the needs of reconstruction.

Key words: Ultrasound, Anterolateral thigh flap, Preoperative planning

CLC Number:

R739.8

HUANG Jian, SHEN Yi, LU Lin-guo, HUANG Guan-lan, ZHOU Hui-hong, CHEN Qian-qian, LI Jun, SUN Jian. Application of high-frequency color ultrasound in preoperative identification and selection of perforator for anterolateral thigh flap grafts[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(1): 42-47.

References

[1] Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects [J]. Plast Reconstr Surg, 1993, 92(3): 421-428.
[2] Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps [J]. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
[3] Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap [J]. Plast Reconstr Surg, 2009, 124(6 Suppl): e395-407.
[4] Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap [J]. Plast Reconstr Surg, 2006, 118(4): 928-933.
[5] Imai R, Matsumura H, Tanaka K, et al. Comparison of Doppler sonography and multidetector-row computed tomography in the imaging findings of the deep inferior epigastric perforator artery [J]. Ann Plast Surg, 2008, 61(1): 94-98.
[6] 肖海涛, 时莹瑜, 王怀胜, 等. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用 [J]. 中国修复重建外科杂志, 2013, 27(2): 178-181.
[7] Golusiński P, Luczewskit, Pazdrowski J, et al. The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap[J]. Eur Arch Otorhinolaryngol,2014,271(5): 1241-1247.
[8] Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning [J]. Ann Plast Surg, 2010, 65(2): 155-160.
[9] Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications [J]. Br J Plast Surg, 1990, 43(1): 1-16.
[10] Shaw RJ, Batstone MD, Blackburn TK, et al. Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap [J]. Br J Oral Maxillofac Surg, 2010, 48(6): 419-422.
[11] Cina A, Salgarello M, Barone-Adesi L, et al. Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler US [J]. Radiology, 2010, 255(3): 979-987.
[12] Arya R, Griffiths L, Figus A, et al. Post-operative assessment of perfusion of deep inferior epigastric perforator (DIEP) free flaps via pulsatility index (PI) using a portable colour Doppler sonogram device [J]. J Plast Reconstr Aesthet Surg, 2013, 66(7): 931-936.
[13] Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study [J]. Microsurgery, 2009, 29(1): 16-23.
[14] Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery [J]. Plast Reconstr Surg, 2009, 123(2): 571-577.
[15] Ensat F, Babl M, Conz C, et al. The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap [J]. Microsurgery, 2012, 32(8): 605-610.
[16] 陆林国, 徐智章, 刘吉斌, 等. 超声造影增强技术在探索穿支皮瓣血管中的应用 [J]. 上海医学影像, 2010, 19(3): 161-164.
[17] Karonidis A, Yao SF. Chimeric anterolateral thigh free flap for head and neck reconstruction [J]. J Plast Reconstr Aesthet Surg, 2009, 62(5): e85-86.
[18] Malhotra A, Chhaya N, Nsiah-Sarbeng P, et al. CT-guided deep inferior epigastric perforator (DIEP) flap localization better for the patient, the surgeon, and the hospital [J]. Clin Radiol, 2013, 68(2): 131-138.
[19] Teunis T, van Voss MR, Kon M, et al. CT-angiography prior to DIEP flap breast reconstruction: a systematic review and meta-analysis [J]. Microsurgery, 2013, 33(6): 496-502.