Kehrer Andreas, Heidekrueger Paul I, Lonic Daniel, Taeger Christian D, Klein Silvan, Lamby Philipp, Sachanadani Neil S, Jung Ernst Michael, Prantl Lukas, Batista da Silva Natascha Platz
Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Royal Oak, Detroit, Michigan.
J Reconstr Microsurg. 2021 Jan;37(1):75-82. doi: 10.1055/s-0040-1702162. Epub 2020 Feb 28.
Preoperative ultrasound (US)-guided perforator mapping has immensely simplified perforator flap planning. It may be executed by the microsurgeon. Device settings and selection of ultrasound modes are of utmost significance for detection of low-flow microvessels. The following study evaluates different US modes.
A prospective complete data acquisition was performed from July 2018 to June 2019 in a subset of patients who underwent US-guided flap planning. Multifrequency linear transducers were used applying five US modes. Brightness (B)-mode, color flow (CF), power Doppler (PD), pulse wave (PW), and B-flow modes were evaluated regarding applicability by microsurgeons. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were chosen to evaluate flow characteristics. US results were correlated to intraoperative findings.
A total number of eight patients (six males and two females) undergoing anterolateral thigh (ALT) or superficial circumflex iliac artery perforator (SCIP) flap surgery received an extensive standardized US-guided perforator characterization. Qualitative evaluation was performed in B-mode, color-coded duplex sonography (CCDS), PD, and B-flow mode. Quantitative assessment was executed using PW-mode and CCDS measuring the microvessels' diameter (mm) and flow characteristics (PSV, EDV, and RI). CCDS provided a mean diameter of 1.93 mm (range: 1.2-2.8 ± 0.51), a mean systolic peak of 16.9 cm/s (range: 9.9-33.4 ± 7.79), and mean RI of 0.71 (range: 0.55-0.87 ± 0.09) for lower limb perforators. All perforators located with US were verified by intraoperative findings. An optimized, time-effective US mapping algorithm was derived. Qualitative parameters may be evaluated with B-mode, CF, or B-flow. Smallest microvessels may be assessed in PD-mode. Lowering pulse-repetition frequency (PRF)/scale is mandatory to image low-flow microvessels as perforators. Quantitative information may be obtained using PW-mode and the distance-measuring tool in CF-mode. Image and video materials are provided.
CCDS proved to be a powerful tool for preoperative perforator characterization when using a structured approach and mapping algorithm. Different techniques may be applied for specific visualizations and performed by the microsurgeon.
术前超声（US）引导下的穿支血管定位极大地简化了穿支皮瓣的设计。这一操作可由显微外科医生完成。设备设置及超声模式的选择对于检测低流量微血管至关重要。以下研究对不同的超声模式进行评估。
2018年7月至2019年6月，对一部分接受超声引导下皮瓣设计的患者进行前瞻性完整数据采集。使用多频率线性换能器，应用五种超声模式。就显微外科医生的适用性而言，对亮度（B）模式、彩色血流（CF）、能量多普勒（PD）、脉冲波（PW）和B-flow模式进行评估。选择收缩期峰值流速（PSV）、舒张末期流速（EDV）和阻力指数（RI）来评估血流特征。超声检查结果与术中发现相关联。
共有8例患者（6例男性和2例女性）接受了股前外侧（ALT）或旋髂浅动脉穿支（SCIP）皮瓣手术，并接受了广泛的标准化超声引导下穿支血管特征分析。在B模式、彩色编码双功超声（CCDS）、PD和B-flow模式下进行定性评估。使用PW模式和CCDS进行定量评估，测量微血管的直径（mm）和血流特征（PSV、EDV和RI）。CCDS显示下肢穿支血管的平均直径为1.93mm（范围：1.2 - 2.8±0.51），平均收缩期峰值为16.9cm/s（范围：9.9 - 33.4±7.79），平均RI为0.71（范围：0.55 - 0.87±0.09）。所有超声定位的穿支血管均经术中发现证实。得出了一种优化的、高效的超声定位算法。定性参数可用B模式、CF或B-flow进行评估。最小的微血管可用PD模式评估。降低脉冲重复频率（PRF）/量程对于将穿支血管等低流量微血管成像至关重要。定量信息可用PW模式和CF模式中的距离测量工具获得。提供了图像和视频资料。
当采用结构化方法和定位算法时，CCDS被证明是术前穿支血管特征分析的有力工具。不同技术可用于特定的可视化，且可由显微外科医生操作。
