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J Reconstr Microsurg 2022; 38(02): 115-120
DOI: 10.1055/s-0041-1731676
Original Article

Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU)

John T. Lindsey Jr
1   Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
,
Christopher Smith
2   Division of Plastic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
,
James Lee
2   Division of Plastic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
,
Hugo St Hilaire
3   Division of Plastic Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
,
John T. Lindsey Sr
2   Division of Plastic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Abstract

Background The first reports of using color Doppler ultrasound for evaluation of the microvasculature were in the 1990s. Despite the early reports of its efficacy, color Doppler ultrasound did not achieve popularity nor general usage in part due to the cumbersome size, cost and poor resolution. This is the first study to demonstrate the potential utility of a new, highly portable, tablet-based color Doppler ultrasound (PT-CDU) system for imaging perforator flaps.

Methods The deep inferior epigastric artery (DIEP), lateral arm (LA), anterolateral thigh (ALT), thoracodorsal artery (TDAP), and the medial sural artery (MSAP) perforator flaps were imaged within classic topographic landmarks to visualize and measure variables related to perforator flap anatomy. The Philips Lumify L12–4 linear array probe attached to the Samsung Galaxy Tab A tablet was the system used for all examinations.

Results A total of 216 flaps were scanned in 50 healthy adult volunteers: 44 DIEP, 44 LA, 40 ALT, 48 TDAP, and 40 MSAP. Precise anatomic information regarding perforator size, number, and location was obtained. Overall, the percent of flaps having at least 1 perforator within the specified topographical landmarks was 89% for the DIEP, 84.1% for the LA, 72.5% for the ALT, 50% for the TDAP, and 30% for the MSAP (p = 2.272e-09). The percent of patients having an asymmetry (right versus left) in the number of perforators was 72.7% (ALT), 65% (DIEP), 59.1% (LA), 41.7% (TDAP), and 30% (MSAP) (p = 0.0351).

Conclusion Portable, tablet-based color Doppler ultrasound offers high-resolution images of perforators and represents a facile technology that may be of interest to microsurgeons in the planning of perforator flaps. Variations in vascular anatomy were well-demonstrated. This surgeon-driven imaging technology may represent an excellent alternative to other imaging modalities.

Keywords

color doppler - perforator flaps - preoperative imaging

Note

This study was presented at the Virtual Plastic Surgery The Meeting (ASPS), October 16–18, 2020.




Publication History

Received: 08 February 2021

Accepted: 12 May 2021

Article published online:
24 August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Hutchinson DT. Color duplex imaging. Applications to upper-extremity and microvascular surgery. Hand Clin 1993; 9 (01) 47-57
    CrossrefPubMedGoogle Scholar
  • 2 Amerhauser A, Moelleken BR, Mathes SJ. et al. Color flow ultrasound for delineating microsurgical vessels: a clinical and experimental study. Ann Plast Surg 1993; 30 (03) 193-202 , discussion 202–203
    CrossrefPubMedGoogle Scholar
  • 3 Chidyllo SA, Jacobs JS. The application of duplex ultrasonography in the preoperative evaluation of patients prior to TRAM flap reconstruction. Plast Reconstr Surg 1993; 92 (01) 174-175
    CrossrefPubMedGoogle Scholar
  • 4 Hallock GG. Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg 1994; 94 (05) 644-651
    CrossrefPubMedGoogle Scholar
  • 5 Cheng HT, Lin FY, Chang SC. Diagnostic efficacy of color Doppler ultrasonography in preoperative assessment of anterolateral thigh flap cutaneous perforators: an evidence-based review. Plast Reconstr Surg 2013; 131 (03) 471e-473e
    CrossrefPubMedGoogle Scholar
  • 6 Hallock GG. Doppler sonography and color duplex imaging for planning a perforator flap. Clin Plast Surg 2003; 30 (03) 347-357 , v–vi
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Miller JP, Carney MJ, Lim S. et al. Ultrasound and plastic surgery: Clinical applications of the newest technology. Ann Plast Surg. 2018; 80 (6S Suppl 6): S356-S361
    PubMedGoogle Scholar
  • 9 Homsy C, McCarthy ME, Lim S. et al. Portable color-flow ultrasound facilitates precision flap planning and perforator selection in reconstructive plastic surgery. Ann Plast Surg 2020; 84 (6S Suppl 5): S424-S430
    CrossrefPubMedGoogle Scholar
  • 10 Ritschl LM, Fichter AM, Bomhard AV. et al. Comparison between different perforator imaging modalities for the anterolateral thigh perforator flap transfer: A prospective study. J Reconstr Microsurg 2020; 36 (09) 686-693
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Xu DC, Zhong SZ, Kong JM. et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988; 82 (02) 305-310
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Rivet D, Buffet M, Martin D. et al. The lateral arm flap: an anatomic study. J Reconstr Microsurg 1987; 3 (02) 121-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Heitmann C, Guerra A, Metzinger SW, Levin LS, Allen RJ. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg 2003; 51 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 16 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96 (07) 1608-1614
    CrossrefPubMedGoogle Scholar
  • 17 Kim HH, Jeong JH, Seul JH, Cho BC. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg 2006; 117 (05) 1609-1618
    CrossrefPubMedGoogle Scholar
  • 18 Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg 2006; 59 (09) 919-926 , discussion 927
    CrossrefPubMedGoogle Scholar
  • 19 Kageyama T. Effective evaluation of SCIV and SIEV as donor vessels by preoperative ultrasound in planning of thin SCIP flaps. J Reconstr Microsurg 2021
    PubMedGoogle Scholar
  • 20 Ishiko M, Yano K, Onode E, Takamatsu K. Identification of ulnar artery perforators using color doppler ultrasonography. J Reconstr Microsurg 2020; 36 (09) 667-672
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Cho MJ, Kwon JG, Pak CJ, Suh HP, Hong JP. The role of duplex ultrasound in microsurgical reconstruction: Review and technical considerations. J Reconstr Microsurg 2020; 36 (07) 514-521
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Kehrer A, Heidekrueger PI, Lonic D. et al. High-resolution ultrasound-guided perforator mapping and characterization by the microsurgeon in lower limb reconstruction. J Reconstr Microsurg 2021; 37 (01) 75-82
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Rozen WM, Ashton MW, Pan WR. et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29 (01) 16-23
    CrossrefPubMedGoogle Scholar
  • 24 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
    CrossrefPubMedGoogle Scholar
  • 25 González Martínez J, Torres Pérez A, Gijón Vega M, Nuñez-Villaveiran T. Preoperative vascular planning of free flaps: Comparative study of computed tomographic angiography, color doppler ultrasonography, and hand-held doppler. Plast Reconstr Surg 2020; 146 (02) 227-237
    CrossrefPubMedGoogle Scholar