Villejuif, France.
From the Division of Plastic and Reconstructive Surgery, Sorbonne Université Hospital Tenon, Gustave Roussy Cancer Campus, Grand Paris.
Plast Reconstr Surg. 2018 Mar;141(3):762-766. doi: 10.1097/PRS.0000000000004117.
Despite numerous advantages, the anterolateral thigh perforator flap suffers from the variable position and nature of its perforators. The aim of the authors' study was to assess the reliability of preoperative color Doppler ultrasound imaging for the exploration of perforator location and course of anterolateral thigh perforator flaps. A prospective cohort study involving patients for whom head and neck reconstruction was planned with thin anterolateral thigh perforator flaps was conducted. Each patient underwent a color Doppler ultrasound exploration of the thighs, in the operating room, immediately before surgery. The sonographer was the surgeon who raised the flaps. Perforators were sought according to surgical needs, and the same location protocol was followed for all of the cases, using an orthonormal coordinate system to report the passages of the perforators through the vastus lateralis aponeurosis. Between January of 2016 and January of 2017, 22 thin anterolateral thigh perforator flaps were successfully harvested. Thirty perforators were located and used. The median distance between the preoperative color Doppler ultrasound planning and the final location of the perforators was 5 mm, statistically smaller than a 10-mm threshold (p = 0.002). Color Doppler ultrasound effectively predicted the nature of the perforators in 90 percent of the cases. The median duration for perforator color Doppler ultrasound location was 3 minutes, statistically shorter than 10 minutes (p = 0.0001). Preoperative color Doppler ultrasound seems to be reliable, accurate, and compatible with a quick routine assessment during patient setup for the elevation of thin anterolateral thigh perforator flaps.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.
目的：评估术前彩色多普勒超声成像在探测穿支位置和股前外侧穿支皮瓣走行中的可靠性。
方法：这是一项前瞻性队列研究，纳入了计划接受薄型股前外侧穿支皮瓣头颈部重建的患者。每位患者在手术前于手术室行彩色多普勒超声检查。行皮瓣切取的术者即为进行超声检查的技师。根据手术需要寻找穿支，并遵循相同的定位方案，使用正交坐标系报告穿支穿过股外侧肌阔筋膜的通道。
结果：2016 年 1 月至 2017 年 1 月，成功采集了 22 例薄型股前外侧穿支皮瓣。定位并使用了 30 个穿支。术前彩色多普勒超声规划与穿支最终位置之间的中位数距离为 5mm，显著小于 10mm 的阈值（p=0.002）。在 90%的病例中，彩色多普勒超声有效地预测了穿支的性质。定位穿支的彩色多普勒超声中位时间为 3 分钟，显著短于 10 分钟（p=0.0001）。
结论：术前彩色多普勒超声似乎可靠、准确，与患者术前准备时快速进行的常规评估兼容，有利于薄型股前外侧穿支皮瓣的切取。
