Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Yu ,  WEI Zairong , ZENG Kewei , ZHANG Fengling , DENG Chengliang , ZHANG Wenduo , WANG Dali

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P.R.China;

Corresponding author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

High frequency color Doppler ultrasound; wide-field imaging; wound repair; anterolateral thigh flap

DOI：

10.7507/1002-1892.201810025

Video：

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Objective To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft.Methods Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly.Results The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly.Conclusion Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

Citation： GUO Yu, WEI Zairong, ZENG Kewei, ZHANG Fengling, DENG Chengliang, ZHANG Wenduo, WANG Dali. Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 190-194. doi: 10.7507/1002-1892.201810025 Copy

1.	徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 2(3): 158-160.
2.	Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-428.
3.	Tsuchiya S, Nakatsuka T, Sakuraba M. One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: report of two cases. Microsurgery, 2011, 31(2): 150-154.
4.	Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg, 1994, 94(5): 644-651.
5.	Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg, 2004, 113(1): 241-246.
6.	Isken T, Alagoz MS, Onyedi M, et al. Preoperative color Doppler assessment in planning of gluteal perforator flaps. Ann Plast Surg, 2009, 62(2): 158-163.
7.	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. 中国修复重建外科杂志, 2013, 27(2): 178-181.
8.	芮永军, 张雁, 杨红, 等. 术前不同定位方法在股前外侧穿支皮瓣应用的对比分析. 中华显微外科杂志, 2015, 38(1): 33-37.
9.	Weng L, Tirumalai AP, Lowery CM, et al. US extended-field-of-view imaging technology. Radiology, 1997, 203(3): 877-880.
10.	常树森, 金文虎, 魏在荣, 等. 股前外侧皮瓣术前设计优化及临床应用. 中华显微外科杂志, 2017, 40(2): 118-122.
11.	朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.
12.	Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
13.	Yildirim S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg, 2003, 19(4): 225-233.
14.	Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
15.	Wolff KD, Hölzle F, Kolk A, et al. Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction: a retrospective study. J Reconstr Microsurg, 2011, 27(4): 225-232.
16.	Choi SW, Park JY, Hur MS, et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg, 2007, 18(4): 866-871.
17.	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. Plast Reconstr Surg, 2009, 123(2): 571-577.
18.	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. Ann Plast Surg, 2010, 65(2): 155-160.
19.	Cheng HT, Lin FY, Chang SC. Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap: A systematic review. Plast Reconstr Surg, 2012, 129(4): 769e-770e.
20.	Rozen WM, Stella DL, Bowden J, et al. Advances in the pre-operative planning of deep inferior epigastric artery perforator flaps: magnetic resonance angiography. Microsurgery, 2009, 29(2): 119-123.
21.	朱艳珊, 许亮, 来蕾, 等. 超声宽景成像对浅表器官病变诊断的价值. 浙江中西医结合杂志, 2006, 16(5): 316-317.
22.	宋达疆, 李赞, 周晓, 等. 游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损. 中国修复重建外科杂志, 2018, 32(5): 607-611.

1. 徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 2(3): 158-160.
2. Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-428.
3. Tsuchiya S, Nakatsuka T, Sakuraba M. One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: report of two cases. Microsurgery, 2011, 31(2): 150-154.
4. Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg, 1994, 94(5): 644-651.
5. Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg, 2004, 113(1): 241-246.
6. Isken T, Alagoz MS, Onyedi M, et al. Preoperative color Doppler assessment in planning of gluteal perforator flaps. Ann Plast Surg, 2009, 62(2): 158-163.
7. 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. 中国修复重建外科杂志, 2013, 27(2): 178-181.
8. 芮永军, 张雁, 杨红, 等. 术前不同定位方法在股前外侧穿支皮瓣应用的对比分析. 中华显微外科杂志, 2015, 38(1): 33-37.
9. Weng L, Tirumalai AP, Lowery CM, et al. US extended-field-of-view imaging technology. Radiology, 1997, 203(3): 877-880.
10. 常树森, 金文虎, 魏在荣, 等. 股前外侧皮瓣术前设计优化及临床应用. 中华显微外科杂志, 2017, 40(2): 118-122.
11. 朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.
12. Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
13. Yildirim S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg, 2003, 19(4): 225-233.
14. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
15. Wolff KD, Hölzle F, Kolk A, et al. Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction: a retrospective study. J Reconstr Microsurg, 2011, 27(4): 225-232.
16. Choi SW, Park JY, Hur MS, et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg, 2007, 18(4): 866-871.
17. 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. Plast Reconstr Surg, 2009, 123(2): 571-577.
18. 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. Ann Plast Surg, 2010, 65(2): 155-160.
19. Cheng HT, Lin FY, Chang SC. Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap: A systematic review. Plast Reconstr Surg, 2012, 129(4): 769e-770e.
20. Rozen WM, Stella DL, Bowden J, et al. Advances in the pre-operative planning of deep inferior epigastric artery perforator flaps: magnetic resonance angiography. Microsurgery, 2009, 29(2): 119-123.
21. 朱艳珊, 许亮, 来蕾, 等. 超声宽景成像对浅表器官病变诊断的价值. 浙江中西医结合杂志, 2006, 16(5): 316-317.
22. 宋达疆, 李赞, 周晓, 等. 游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损. 中国修复重建外科杂志, 2018, 32(5): 607-611.

Chinese Journal of Reparative and Reconstructive Surgery

Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery

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