APPLICATION OF HIGH FREQUENCY COLOR DOPPLER ULTRASOUND IN ANTEROLATERAL THIGH FLAP SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAO Haitao ¹ , SHI Yingyu ² , WANG Huaisheng ¹ , LIU Yong ¹ , ZHANG Yange ¹ , CEN Ying ¹

1Department of Burn and Plastic Surgery, 2Department of Ultrasound, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: CEN Ying, E-mail: cenying0141@163.com;

Corresponding author：

Keywords：

High frequency color; Doppler ultrasound; Anterolateral thigh flap; Perforator flap

DOI：

10.7507/1002-1892.20130040

Video：

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Objective To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh (ALT) flap surgery. Methods Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years (mean, 34 years). Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm × 7 cm to 22 cm × 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm × 9 cm to 25 cm × 20 cm. The donnor sites were repaired by free skin graft. Results Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months (mean, 8 months). The flaps had good color and texture. Conclusion High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.

Citation： XIAO Haitao,SHI Yingyu,WANG Huaisheng,LIU Yong,ZHANG Yange,CEN Ying. APPLICATION OF HIGH FREQUENCY COLOR DOPPLER ULTRASOUND IN ANTEROLATERAL THIGH FLAP SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 178-181. doi: 10.7507/1002-1892.20130040 Copy

1.	李利平, P. C. Neligan. 股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损. 中国修复重建外科杂志, 2007, 21(4): 340-342.
2.	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(1): 16-23.
3.	Tang CL, Wu YC, Lai CH, et al. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg, 2012, 46(5): 335-338.
4.	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.
5.	Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: Review of 20 consecutive cases. J Plast Reconstr Aesthetic Surg, 2012, 65(11): 1525-1529.
6.	Liang CC, Jeng SF, Yang JC, et al. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg, 2012. [Epub ahead of print].
7.	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.
8.	刘会仁, 李瑞国, 高顺红, 等. 股前外侧皮瓣的多普勒探测研究和设计改进. 中国修复重建外科杂志, 2006, 20(7): 722-724.
9.	Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10.	Knobloch K, Gohritz A, Reuss E, et al. Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany. Plast Reconstr Surg, 2008, 121(1): 183e-184e.
11.	任义军, 任高宏, 金丹, 等. 数字化股前外侧皮瓣的可视技术在临床中的初步应用. 中华创伤骨科杂志, 2008, 10(5): 432-435.
12.	陆声, 徐永清, 张元智, 等. CT血管造影及可视化研究在背阔肌肌皮瓣移植中的临床应用. 中国修复重建外科杂志, 2009, 23(7): 818-821.
13.	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.
14.	Heo C, Eun S, Bae R, et al. Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography. J Plast Reconstr Aesthet Surg, 2010, 63(5): e465-468.
15.	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.
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. 上海医学影像, 2010, 19(3): 161-164.
17.	陆林国, 徐秋华, 燕山, 等. 高频彩超对穿支皮瓣血管的探索研究. 上海医学影像, 2008, 17(3): 200-202.
18.	Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.

1. 李利平, P. C. Neligan. 股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损. 中国修复重建外科杂志, 2007, 21(4): 340-342.
2. 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(1): 16-23.
3. Tang CL, Wu YC, Lai CH, et al. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg, 2012, 46(5): 335-338.
4. 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.
5. Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: Review of 20 consecutive cases. J Plast Reconstr Aesthetic Surg, 2012, 65(11): 1525-1529.
6. Liang CC, Jeng SF, Yang JC, et al. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg, 2012. [Epub ahead of print].
7. 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.
8. 刘会仁, 李瑞国, 高顺红, 等. 股前外侧皮瓣的多普勒探测研究和设计改进. 中国修复重建外科杂志, 2006, 20(7): 722-724.
9. Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10. Knobloch K, Gohritz A, Reuss E, et al. Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany. Plast Reconstr Surg, 2008, 121(1): 183e-184e.
11. 任义军, 任高宏, 金丹, 等. 数字化股前外侧皮瓣的可视技术在临床中的初步应用. 中华创伤骨科杂志, 2008, 10(5): 432-435.
12. 陆声, 徐永清, 张元智, 等. CT血管造影及可视化研究在背阔肌肌皮瓣移植中的临床应用. 中国修复重建外科杂志, 2009, 23(7): 818-821.
13. 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.
14. Heo C, Eun S, Bae R, et al. Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography. J Plast Reconstr Aesthet Surg, 2010, 63(5): e465-468.
15. 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.
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. 上海医学影像, 2010, 19(3): 161-164.
17. 陆林国, 徐秋华, 燕山, 等. 高频彩超对穿支皮瓣血管的探索研究. 上海医学影像, 2008, 17(3): 200-202.
18. Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF HIGH FREQUENCY COLOR DOPPLER ULTRASOUND IN ANTEROLATERAL THIGH FLAP SURGERY

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