对比增强超声联合三维重建在穿支皮瓣术前规划中的应用。
Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning.
机构信息
Shanghai, People's Republic of China; Florence and Pisa, Italy; and Philadelphia, Pa. From the Departments of Plastic and Reconstructive Surgery and Ultrasound Diagnosis, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; the Reconstructive Microsurgery and Maxillofacial Surgery Units, Hospital of Florence; the Plastic and Reconstructive Surgery Unit, Hospital of Pisa; and the Department of Orthopedic Surgery, Hospital of University of Pennsylvania.
出版信息
Plast Reconstr Surg. 2013 Jan;131(1):80-93. doi: 10.1097/PRS.0b013e3182729e9e.
BACKGROUND
Along with technical advancements in perforator flap surgery, great interest has been recently focused on the accuracy of preoperative perforator location through the assessment of the donor-site vascular network. The goal of the present study was to investigate the usefulness of contrast-enhanced ultrasound combined with three-dimensional reconstruction in the planning of perforator flaps.
METHODS
The authors retrospectively analyzed the preoperative imaging vascular anatomy provided by contrast-enhanced ultrasound combined with three-dimensional reconstruction in 32 patients undergoing perforator flap reconstruction between 2009 and 2011. The static and dynamic features of any suitable perforator including number of branches, source vessel, running course, blood flow pattern and velocity (peak systolic velocity and resistance index), and its anatomical relationship were assessed preoperatively by the novel navigation imaging. Based on this information, the preferred perforator and the ideal donor site were selected for the flap harvesting. The accuracy of preoperative imaging data was checked during surgery.
RESULT
Contrast-enhanced ultrasound provided a continuous blood flow signal and a clear and reliable image of perforators, and three-dimensional reconstruction displayed their spatial anatomical relationship and their roots. Consistent with the surgical findings, perforators were identified accurately in all 32 cases with high specificity (100 percent) and sensitivity.
CONCLUSIONS
Contrast-enhanced ultrasound with three-dimensional image reconstruction provides valuable preoperative perforator navigation. It detects precisely the perforator's location, its course, and the quality of its blood flow and allows the choice of the preferred perforator and the ideal donor site. Preoperative location of perforators using contrast-enhanced ultrasound with three-dimensional image reconstruction improves flap planning and eases flap harvesting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
背景
随着穿支皮瓣手术技术的进步，人们最近对通过评估供区血管网络来准确确定穿支位置产生了浓厚的兴趣。本研究的目的是探讨超声造影联合三维重建在穿支皮瓣设计中的应用价值。
方法
作者回顾性分析了 2009 年至 2011 年间 32 例行穿支皮瓣重建术患者的术前超声造影联合三维重建的血管解剖图像。应用新型导航成像技术对包括分支数量、起源血管、走行、血流模式和速度（收缩期峰值流速和阻力指数）等任何合适穿支的静态和动态特征及其解剖关系进行术前评估。根据这些信息，选择皮瓣获取的首选穿支和理想供区。术中检查术前影像学数据的准确性。
结果
超声造影提供了连续的血流信号和清晰可靠的穿支图像，三维重建显示了其空间解剖关系及其根源。与手术结果一致，32 例患者均准确识别出穿支，特异性为 100%，敏感性为 100%。
结论
超声造影联合三维图像重建可提供有价值的术前穿支导航。它可以精确检测穿支的位置、走行以及血流质量，并允许选择首选穿支和理想供区。术前使用超声造影联合三维图像重建定位穿支可改善皮瓣设计，便于皮瓣获取。
临床问题/证据水平：诊断，IV。
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