Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Reconstr Microsurg. 2020 Nov;36(9):686-693. doi: 10.1055/s-0040-1714425. Epub 2020 Jul 26.
Perforator imaging is routinely performed before perforator flap harvest. Hand-held Doppler (hhD) and color duplex ultrasonography (CDU) are currently the most popular radiation-free methods for this purpose that can be applied by the surgeon alone. The aim of this study was to compare the accuracy, reliability, and feasibility of hhD and CDU with indocyanine green angiography (ICGA) in the anterolateral thigh perforator flap (ALTPF).
All consecutive ALTPF procedures between May 2017 and April 2018 were included in this prospective study. The perforators were visualized by three investigators independently and randomized, applying hhD, CDU, and ICGA. The presence and the distance to the identified perforator were registered. Further, body mass index (BMI), American Society of Anesthesiologists-status, and the patient's history regarding smoking, alcohol use, and diabetes mellitus were registered alongside gender and age to analyze possible confounders.
A total of 12 patients were enrolled with a median age of 67 (52-87) years. In total, 30 perforators were detected intraoperatively as well as with the ICGA. The latter visualized the perforators significantly more precisely than hhD and CDU ( < 0.001 and = 0.001). The sensitivity and positive predictive value were 67 and 62% for hhD, 73 and 64% for CDU, and 100 and 100% for ICGA, respectively.
According to this study, ICGA visualized perforators more accurately than the standard methods hhD and CDU. Further, it was associated with the highest sensitivity and positive predictive value. ICGA consistently delivered excellent results, whereas hhD and CDU showed variability.
穿支皮瓣采集前通常会进行穿支成像。手持式多普勒（hhD）和彩色双功能超声（CDU）是目前最常用的无辐射方法，可由外科医生单独使用。本研究旨在比较 hhD 和 CDU 与吲哚菁绿血管造影（ICGA）在股前外侧皮瓣（ALTPF）中的准确性、可靠性和可行性。
本前瞻性研究纳入了 2017 年 5 月至 2018 年 4 月期间所有连续进行的 ALTPF 手术。由三位独立的研究人员随机使用 hhD、CDU 和 ICGA 观察皮穿支。记录皮穿支的存在和到其的距离。此外，还记录了患者的体重指数（BMI）、美国麻醉医师协会（ASA）状态以及吸烟、饮酒和糖尿病史等信息，以分析可能的混杂因素。
共纳入 12 例患者，中位年龄为 67（52-87）岁。共术中检测到 30 个皮穿支，同时也用 ICGA 检测到了这些皮穿支。与 hhD 和 CDU 相比，ICGA 更精确地显示了皮穿支（ < 0.001 和 = 0.001）。hhD 的灵敏度和阳性预测值分别为 67%和 62%，CDU 分别为 73%和 64%，而 ICGA 分别为 100%和 100%。
根据本研究，ICGA 比标准的 hhD 和 CDU 方法更准确地显示了皮穿支。此外，它具有最高的灵敏度和阳性预测值。ICGA 始终能提供出色的结果，而 hhD 和 CDU 则表现出了可变性。
