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DOI: 10.1055/s-0040-1709479
The Role of Duplex Ultrasound in Microsurgical Reconstruction: Review and Technical Considerations
Publikationsverlauf
23. November 2019
12. Februar 2020
Publikationsdatum:
29. April 2020 (online)
Abstract
Background With the technological advances, microsurgery has evolved to the era of supermicrosurgery since its inception. With the popularization of these flaps, proficiency in using tools such as color Doppler ultrasound (CDU) has become crucial. Despite the increased interest, studies regarding the role of ultrasound in microsurgical reconstruction are scarce. Therefore, in this study, we discussed currently available imaging modalities for reconstructive surgeons, types of ultrasound, and the role of ultrasound in microsurgical reconstruction, and made recommendations for ultrasound use in reconstructive surgery.
Methods We performed a computerized search of ultrasound in reconstructive surgery using the MEDLINE database. Data regarding ultrasound indications, usage, and outcomes were collected.
Results Of the 115 articles identified, the majority was written on nonreconstructive ultrasound uses (51.4%). For the reconstructive uses, mapping of perforators was the most common usage (39.1%), followed by flap monitoring and volume measurement. In addition, we found that there are a limited number of literature on the role of CDU in reconstructive surgery, especially on its intraoperative and postoperative use.
Conclusion CDU is a valuable and powerful tool for any reconstructive surgeons who are interested in performing microsurgery or supermicrosurgery. As the demand of customized flaps using superthin flaps, perforator-to-perforator anastomosis, and supermicrosurgery increases, understanding and becoming versatile in CDU will be critical. We hope our experience with using ultrasound and refinements that we made are helpful for those who would like to include it as a part of their armamentarium.
Authors' Contributions
M.J.C. conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. J.G.K. gathered data and video for the manuscript as well as take part in the draft. H.Y.S. and J.P.H. conceptualized and designed the study, critically revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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References
- 1 Gordon L. Advances in microsurgery. Surg Technol Int 1991; I: 425-427
- 2 Tamai S. History of microsurgery. Plast Reconstr Surg 2009; 124 (06) e282-e294
- 3 Hong JPJ, Song S, Suh HSP. Supermicrosurgery: principles and applications. J Surg Oncol 2018; 118 (05) 832-839
- 4 Suh HS, Oh TS, Lee HS. , et al. A new approach for reconstruction of diabetic foot wounds using the angiosome and supermicrosurgery concept. Plast Reconstr Surg 2016; 138 (04) 702e-709e
- 5 Badash I, Gould DJ, Patel KM. Supermicrosurgery: history, applications, training and the future. Front Surg 2018; 5: 23
- 6 Mohan AT, Saint-Cyr M. Advances in imaging technologies for planning breast reconstruction. Gland Surg 2016; 5 (02) 242-254
- 7 Pratt GF, Rozen WM, Chubb D, Ashton MW, Alonso-Burgos A, Whitaker IS. Preoperative imaging for perforator flaps in reconstructive surgery: a systematic review of the evidence for current techniques. Ann Plast Surg 2012; 69 (01) 3-9
- 8 Chae MP, Hunter-Smith DJ, Rozen WM. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction. Gland Surg 2015; 4 (02) 164-178
- 9 Tong WM, Dixon R, Ekis H, Halvorson EG. The impact of preoperative CT angiography on breast reconstruction with abdominal perforator flaps. Ann Plast Surg 2012; 68 (05) 525-530
- 10 Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175 (03) 621-628
- 11 Dillman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC. Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. AJR Am J Roentgenol 2007; 189 (06) 1533-1538
- 12 Chernyak V, Rozenblit AM, Greenspun DT. , et al. Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators. Radiology 2009; 250 (02) 417-424
- 13 Greenspun D, Vasile J, Levine JL. , et al. Anatomic imaging of abdominal perforator flaps without ionizing radiation: seeing is believing with magnetic resonance imaging angiography. J Reconstr Microsurg 2010; 26 (01) 37-44
- 14 Newman TM, Vasile J, Levine JL. , et al. Perforator flap magnetic resonance angiography for reconstructive breast surgery: a review of 25 deep inferior epigastric and gluteal perforator artery flap patients. J Magn Reson Imaging 2010; 31 (05) 1176-1184
- 15 Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 2008; 121 (01) 9-16
- 16 Aubry S, Pauchot J, Kastler A, Laurent O, Tropet Y, Runge M. Preoperative imaging in the planning of deep inferior epigastric artery perforator flap surgery. Skeletal Radiol 2013; 42 (03) 319-327
- 17 Chang BW, Luethke R, Berg WA, Hamper UM, Manson PN. Two-dimensional color Doppler imaging for precision preoperative mapping and size determination of TRAM flap perforators. Plast Reconstr Surg 1994; 93 (01) 197-200
- 18 Rozen WM, Phillips TJ, Stella DL, Ashton MW. Preoperative CT angiography for DIEP flaps: ‘must-have’ lessons for the radiologist. J Plast Reconstr Aesthet Surg 2009; 62 (12) e650-e651
- 19 Wade RG, Watford J, Wormald JCR, Bramhall RJ, Figus A. Perforator mapping reduces the operative time of DIEP flap breast reconstruction: a systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography. J Plast Reconstr Aesthet Surg 2018; 71 (04) 468-477
- 20 Oni G, Chow W, Ramakrishnan V, Griffiths M. Plastic surgeon-led ultrasound. Plast Reconstr Surg 2018; 141 (02) 300e-309e
- 21 Solomon GA, Yaremchuk MJ, Manson PN. Doppler ultrasound surface monitoring of both arterial and venous flow in clinical free tissue transfers. J Reconstr Microsurg 1986; 3 (01) 39-41
- 22 Hallock GG. Doppler sonography and color duplex imaging for planning a perforator flap. Clin Plast Surg 2003; 30 (03) 347-357
- 23 Blondeel PN, Beyens G, Verhaeghe R. , et al. Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 1998; 51 (03) 202-209
- 24 Hallock GG. Color duplex imaging for identifying perforators prior to pretransfer expansion of fasciocutaneous free flaps. Ann Plast Surg 1994; 32 (06) 595-601
- 25 Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg 1994; 94 (05) 644-651
- 26 Vakharia KT, Henstrom D, Lindsay R, Cunnane MB, Cheney M, Hadlock T. Color Doppler ultrasound: effective monitoring of the buried free flap in facial reanimation. Otolaryngol Head Neck Surg 2012; 146 (03) 372-376
- 27 Seres L, Makula E, Morvay Z, Borbely L. Color Doppler ultrasound for monitoring free flaps in the head and neck region. J Craniofac Surg 2002; 13 (01) 75-78
- 28 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
- 29 Koshima I, Narushima M, Mihara M. , et al. New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb. J Plast Reconstr Aesthet Surg 2010; 63 (01) 140-145
- 30 Gentileschi S, Servillo M, De Bonis F. , et al. Radioanatomical study of the pedicle of the superficial circumflex iliac perforator flap. J Reconstr Microsurg 2019; 35 (09) 669-676
- 31 Sheriff HO, Mahmood KA, Hamawandi N. , et al. The supraclavicular artery perforator flap: a comparative study of imaging techniques used in preoperative mapping. J Reconstr Microsurg 2018; 34 (07) 499-508
- 32 Akita S, Yamaji Y, Kuriyama M. , et al. Intraoperative detection of efferent lymphatic vessels emerging from lymph node during lymphatic microsurgery. J Reconstr Microsurg 2019; 35 (05) 372-378
- 33 Pereira N, Lee YH, Suh Y. , et al. Cumulative experience in lymphovenous anastomosis for lymphedema treatment: the learning curve effect on the overall outcome. J Reconstr Microsurg 2018; 34 (09) 735-741
- 34 Visconti G, Bianchi A, Hayashi A, Salgarello M. Pure skin perforator flap direct elevation above the subdermal plane using preoperative ultra-high frequency ultrasound planning: a proof of concept. J Plast Reconstr Aesthet Surg 2019; 72 (10) 1700-1738
- 35 Tashiro K, Harima M, Kato M. , et al. Preoperative color Doppler ultrasound assessment in planning of SCIP flaps. J Plast Reconstr Aesthet Surg 2015; 68 (07) 979-983
- 36 Tashiro K, Yamashita S, Araki J, Narushima M, Iida T, Koshima I. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg 2016; 69 (03) 346-350
- 37 Piorkowski JR, DeRosier LC, Nickerson P, Fix RJ. Preoperative computed tomography angiogram to predict patients with favorable anatomy for superficial inferior epigastric artery flap breast reconstruction. Ann Plast Surg 2011; 66 (05) 534-536
- 38 Hayashi A, Giacalone G, Yamamoto T. , et al. Ultra high-frequency ultrasonographic imaging with 70 MHz scanner for visualization of the lymphatic vessels. Plast Reconstr Surg Glob Open 2019; 7 (01) e2086
- 39 Visconti G, Hayashi A, Yoshimatsu H, Bianchi A, Salgarello M. Ultra-high frequency ultrasound in planning capillary perforator flaps: preliminary experience. J Plast Reconstr Aesthet Surg 2018; 71 (08) 1146-1152