Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Dong ¹ , LIU Liang ¹ ,  ZHANG Kai ¹ , XU Tao ¹ , LIAO Shengkai ¹ , WANG Xiaomin ² , HAN Rui ¹ , LIU Yangyang ³ , GUO Zhenfei ¹

1. Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P.R.China;
2. Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P.R.China;
3. Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P.R.China;

Corresponding author：

ZHANG Kai, Email: zk29788@163.com

Keywords：

Color Doppler ultrasound; contrast-enhanced ultrasound; superficial inferior epigastric artery perforator flap; oral

DOI：

10.7507/1002-1892.202005102

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Objective To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap.Methods Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien’s donor area, the recovery of transoral feeding function, and the presence of complications.Results Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements (P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant (t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed.Conclusion The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.

Citation： WANG Dong, LIU Liang, ZHANG Kai, XU Tao, LIAO Shengkai, WANG Xiaomin, HAN Rui, LIU Yangyang, GUO Zhenfei. Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1417-1422. doi: 10.7507/1002-1892.202005102 Copy

1.	唐举玉, 汪华侨, 章一新, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
2.	Lohasammakul S, Turbpaiboon C, Ratanalekha R, et al. Anatomy of superficial inferior epigastric vessels: revival of superficial inferior epigastric (SIEA) flap. Eur J Plast Surg, 2018, 41(3): 317-324.
3.	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(7): 979-983.
4.	Mueller S, Wendl CM, Ettl T, et al. Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery. Clin Hemorheol Microcirc, 2017, 65(4): 317-325.
5.	张敬良. 努力追求创面修复的“泳裤供区”理念. 中华显微外科杂志, 2020, 43(1): 3-4.
6.	张凯, 王栋, 高廷益, 等. 彩色多普勒超声辅助下腹部浅动脉供血皮瓣修复颌面部软组织缺损. 中华整形外科杂志, 2019, 35(12): 1200-1204.
7.	Ngaage LM, Hamed R, Oni G, et al. The role of CT angiography in assessing deep inferior epigastric perforator flap patency in patients with pre-existing abdominal scars. J Surg Res, 2019, 235: 58-65.
8.	王栋, 刘亮, 杨东昆, 等. 腹壁浅动脉穿支皮瓣一期修复口腔癌术后软组织缺损三例. 中华显微外科杂志, 2019, 42(6): 579-582.
9.	Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg, 1971, 24(1): 15-19.
10.	Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg, 1975, 56(3): 243-253.
11.	Rozen WM, Chubb D, Grinsell D, et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
12.	Kim BJ, Choi JH, Kim TH, et al. The superficial inferior epigastric artery flap and its relevant vascular anatomy in korean women. Arch Plast Surg, 2014, 41(6): 702-708.
13.	Salibian AH, Menick FJ, Talley J. Microvascular reconstruction of the nose with the radial forearm flap: A 17-year experience in 47 patients. Plast Reconstr Surg, 2019, 144(1): 199-210.
14.	Prantl L, Geis S, Lamby P, et al. Recommendations for contrast enhanced ultrasound (CEUS) in free tissue transplant monitoring. Clin Hemorheol Microcirc, 2015, 61(2): 359-365.
15.	陆林国, 徐智章, 刘吉斌, 等. 超声造影及三维重建对腹壁下动脉穿支皮瓣血管的探索性研究. 中华超声影像学杂志, 2014, 23(6): 520-523.
16.	Su W, Lu L, Lazzeri D, et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg, 2013, 131(1): 80-93.
17.	Gao Y, Yuan Y, Li H, et al. Preoperative imaging for thoracic branch of supraclavicular artery flap: A comparative study of contrast-enhanced ultrasound with three-dimensional reconstruction and color duplex ultrasound. Ann Plast Surg, 2016, 77(2): 201-205.

1. 唐举玉, 汪华侨, 章一新, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
2. Lohasammakul S, Turbpaiboon C, Ratanalekha R, et al. Anatomy of superficial inferior epigastric vessels: revival of superficial inferior epigastric (SIEA) flap. Eur J Plast Surg, 2018, 41(3): 317-324.
3. 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(7): 979-983.
4. Mueller S, Wendl CM, Ettl T, et al. Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery. Clin Hemorheol Microcirc, 2017, 65(4): 317-325.
5. 张敬良. 努力追求创面修复的“泳裤供区”理念. 中华显微外科杂志, 2020, 43(1): 3-4.
6. 张凯, 王栋, 高廷益, 等. 彩色多普勒超声辅助下腹部浅动脉供血皮瓣修复颌面部软组织缺损. 中华整形外科杂志, 2019, 35(12): 1200-1204.
7. Ngaage LM, Hamed R, Oni G, et al. The role of CT angiography in assessing deep inferior epigastric perforator flap patency in patients with pre-existing abdominal scars. J Surg Res, 2019, 235: 58-65.
8. 王栋, 刘亮, 杨东昆, 等. 腹壁浅动脉穿支皮瓣一期修复口腔癌术后软组织缺损三例. 中华显微外科杂志, 2019, 42(6): 579-582.
9. Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg, 1971, 24(1): 15-19.
10. Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg, 1975, 56(3): 243-253.
11. Rozen WM, Chubb D, Grinsell D, et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
12. Kim BJ, Choi JH, Kim TH, et al. The superficial inferior epigastric artery flap and its relevant vascular anatomy in korean women. Arch Plast Surg, 2014, 41(6): 702-708.
13. Salibian AH, Menick FJ, Talley J. Microvascular reconstruction of the nose with the radial forearm flap: A 17-year experience in 47 patients. Plast Reconstr Surg, 2019, 144(1): 199-210.
14. Prantl L, Geis S, Lamby P, et al. Recommendations for contrast enhanced ultrasound (CEUS) in free tissue transplant monitoring. Clin Hemorheol Microcirc, 2015, 61(2): 359-365.
15. 陆林国, 徐智章, 刘吉斌, 等. 超声造影及三维重建对腹壁下动脉穿支皮瓣血管的探索性研究. 中华超声影像学杂志, 2014, 23(6): 520-523.
16. Su W, Lu L, Lazzeri D, et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg, 2013, 131(1): 80-93.
17. Gao Y, Yuan Y, Li H, et al. Preoperative imaging for thoracic branch of supraclavicular artery flap: A comparative study of contrast-enhanced ultrasound with three-dimensional reconstruction and color duplex ultrasound. Ann Plast Surg, 2016, 77(2): 201-205.

Chinese Journal of Reparative and Reconstructive Surgery

Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects

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