Quantitative Assessment of Bone Microvascularization After Osteocutaneous Flap Transplantation Using Contrast-Enhanced Ultrasound (CEUS)

Abstract

Background: Extensive wound defects frequently have to be covered by free flap transplantation. A monitoring device for measuring capillary level perfusion of bone is currently not available.

Objective: The aim of the study was to detect complications after osteocutaneous flap transplantation using contrast-enhanced ultrasound (CEUS). Additionally quantitative analysis was performed by special perfusion software (QONTRAST^®; Bracco, Italy).

Methods: 22 patients were examined after osteocutaneous flap transplantation during the first 72 h after operation. CEUS was performed with a linear transducer (6 – 9 MHz, LOGIQ E9/GE) after bolus injections of 2.4 ml ultrasound contrast agent (SonoVue^®; Bracco, Italy). The osseous perfusion and soft tissue perfusion were analyzed separately and quantitative perfusion analysis was performed. Five patients had to undergo reoperation due to compromised flap microvascularization.

Results: In all 5 complications reduced osseous and soft tissue perfusion was seen using CEUS. Additionally using the perfusion parameters TTP (time to PEAK), RBV (regional blood volume), RBF (regional blood flow) und MTT (mean transit time), significantly lower soft tissue and osseous perfusion was detected.

Conclusion: CEUS seems to be capable of detecting vascular disturbances and of assessing microvascularization of the osseous component after osteocutaneous flap transplantation.

Zusammenfassung

Ziel: In vielen Situationen ist die freie Lappenplastik die einzige Option zur Deckung großer Weichteildefekte. Die Komplikationsrate nach freier Lappentransplantation beläuft sich auf 5 – 10 %. Aktuell existieren keinerlei Systeme zur Beurteilung der Knochenperfusion oder zur Beurteilung tiefer gelegener Gewebeschichten.

Fragestellung: Ziel dieser Studie war die Erfassung von Komplikationen nach freier osteokutaner Lappentransplantation mit Hilfe von Kontrastmittelultraschall (CEUS) sowie die quantitative Auswertung der Knochenperfusion mit Hilfe einer speziellen Perfusionssoftware (QONTRAST^®; Bracco, Italy).

Material und Methodik: 22 Patienten wurden in der Studie eingeschlossen. Die Kontrastmittelultraschalluntersuchung wurde nach einer Bolus-Injektion von 2,4 ml Kontrastmittel (SonoVue^®; Bracco, Italy) mit einem linearen Schallkopf (6 – 9 MHz, LOGIQ E9/GE) innerhalb der ersten 72 postoperativen Stunden durchgeführt. Die Weichteilperfusion und die Knochenperfusion wurde anhand separater regions of interest mit Hilfe der Perfusionssoftware semi-quantitativ ausgewertet. In fünf Fällen musste aufgrund einer eingeschränkten Lappendurchblutung ein Revisionseingriff durchgeführt werden.

Ergebnisse: In allen fünf Komplikationen konnte sowohl eine reduzierte Kontrastmittelanflutung als auch ein verzögertes Auswaschen des Kontrastmittel beobachtet werden. Mit Hilfe der Perfusionsparameter TTP (time to PEAK), RBV (regionales Blutvolumen), RBF (regionaler Blutfluss) und MTT (mittlere Verweildauer des Kontrastmittels) konnte eine signifikant niedrigere Weichteilperfusion und Knochenperfusion detektiert werden.

Schlussfolgerung: Es konnte gezeigt werden, dass sich der Kontrastmittel Ultraschall zur Erfassung kritischer Durchblutungsstörungen nach freier osteokutaner Lappentransplantation durchaus eignet.

Key words

bones - soft tissues - contrast agents - CEUS - contrast-enhanced ultrasound

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