Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Microsurgery. 2020 Jul;40(5):561-567. doi: 10.1002/micr.30599. Epub 2020 May 5.
The anterior lateral thigh (ALT) flap's vascular variability can lead to complications. Thus, the accuracy of numerous planning modalities has been studied. The clinical relevance of competing mapping methods, however, remains unknown. Therefore, we compared the impact of color-coded Duplex ultrasonography and handheld audible Dopplers on surgical efficacy and flap safety.
Forty-four ALT flaps were included in this comparative retrospective monocentric study. Twelve patients received Duplex scans and 32 flaps were designed using Dopplers only. Patient, defect, and flap characteristics of both groups were analyzed. The effect of either planning method on the primary outcome variables - flap harvest and operative times (HT, OT), course of perforator dissection, incidence of flap loss, emergent re-explorations, and donor-site revisions - was then assessed.
Patient, defect, and flap characteristics were comparable between both groups, including flap size (Doppler: 134 ± 73 cm , Duplex: 131 ± 65 cm , p = .90). There was no flap loss. Emergent re-explorations (Doppler: 4/32, Duplex: 1/12, p = .70) and donor-site revisions (Doppler: 2/32, Duplex: 1/12, p = .81) were equally distributed. Duplex rendered septal perforator dissection 10 times more likely (Chi-Square = 8.9, p = .003, OR = 9.7), reaching 50% (n = 6/12), as opposed to only 9% in the Doppler cohort (n = 3/32). This allowed for highly significant HT and OT reductions of 89 minutes, respectively (p < .01): from 255 and 383 min (Doppler) to 166 and 294 min (Duplex).
Preoperative Duplex significantly reduces harvest and operative times of ALT flaps.
前外侧大腿（ALT）皮瓣的血管变异性可能导致并发症。因此，已经研究了许多规划方式的准确性。然而，竞争映射方法的临床相关性尚不清楚。因此，我们比较了彩色编码双功能超声和手持听诊多普勒对手术效果和皮瓣安全性的影响。
本比较回顾性单中心研究纳入了 44 例 ALT 皮瓣。12 例患者接受了双功能超声扫描，32 例皮瓣仅使用多普勒设计。分析了两组患者、缺陷和皮瓣特征。然后评估了任何一种规划方法对主要结局变量——皮瓣采集和手术时间（HT、OT）、穿支解剖过程、皮瓣失效率、紧急再次探查和供区修正——的影响。
两组患者、缺陷和皮瓣特征相当，包括皮瓣大小（多普勒：134±73cm，双功能超声：131±65cm，p=0.90）。没有皮瓣失活。紧急再次探查（多普勒：4/32，双功能超声：1/12，p=0.70）和供区修正（多普勒：2/32，双功能超声：1/12，p=0.81）的发生率相当。双功能超声使间隔穿支解剖的可能性增加了 10 倍（卡方=8.9，p=0.003，OR=9.7），达到 50%（n=6/12），而多普勒组仅为 9%（n=3/32）。这使得 HT 和 OT 分别显著减少了 89 分钟（p<0.01）：从多普勒组的 255 和 383 分钟降至双功能超声组的 166 和 294 分钟。
术前双功能超声显著缩短了 ALT 皮瓣的采集和手术时间。
