Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Radiology, Ultrasound Center, University Medical Center Regensburg, Regensburg, Germany.
J Reconstr Microsurg. 2022 Mar;38(3):181-192. doi: 10.1055/s-0041-1740956. Epub 2022 Jan 17.
Technical aspects are of utmost significance for an efficient execution in designing perforator flaps with high-resolution color-coded Duplex sonography (CCDS). The following study evaluates decisive factors for a successful microvessel examination conducted by the microsurgeon.
Technical knowledge presented in this study was based on a series of more than 200 perforator flaps planned with CCDS. Flap reconstructions were performed at the University Hospital Regensburg, Germany, from July 2013 to January 2021. Standard high-resolution ultrasound (US) devices with linear multifrequency transducers of 4 to 18 MHz were used. Modes and device settings were evaluated regarding applicability by microsurgeons. Key steps for safe perforator identification and further optional steps for additional assessment should be discriminated.
Different US modes including brightness mode (B-mode), color flow (CF), power Doppler (PD), pulse wave (PW), and blood flow (B-Flow) were used. Transducers from 15 MHz and up were favorable to detect microvessels. Knobology of a standard US device regarding buttons, switches, and specific onscreen options with relevance for perforator mapping was subcategorized in four different groups. For qualitative and quantitative evaluation of microvessels, different US modes were tested with respect to their usefulness.Vital elements of the CCDS exam are disaggregated into three key steps for safe perforator identification and three optional steps for further perforator characterization. A standardized protocol for the CCDS exams was applied. Downregulation of pulse-repetition frequency/scale to adapt device sensitivity to slow-flow velocities represented the most important criterion to visualize microvessels.Qualitative microvessel evaluation was performed in B-mode, CCDS, PD mode, and B-Flow mode. Quantitative assessment was executed using PW-mode and CCDS measuring the microvessels' diameter (mm) and flow characteristics. Quantitative information may be obtained using PW-mode and the distance-measuring tool in CF-mode.
Technical aspects with respect to proper device trimming and application decisively impact CCDS-guided perforator vessel identification and evaluation.
在使用高分辨率彩色编码双功能超声（CCDS）设计穿支皮瓣时，技术方面至关重要。本研究评估了显微外科医生进行成功微血管检查的决定性因素。
本研究中的技术知识基于使用 CCDS 规划的 200 多个穿支皮瓣系列。皮瓣重建于 2013 年 7 月至 2021 年 1 月在德国雷根斯堡大学医院进行。使用标准的高分辨率超声（US）设备，线性多频探头为 4 至 18 MHz。显微外科医生评估了模式和设备设置的适用性。应区分安全识别穿支血管的关键步骤和进一步评估的可选步骤。
使用了不同的 US 模式，包括亮度模式（B 模式）、彩色血流（CF）、能量多普勒（PD）、脉冲波（PW）和血流（B-Flow）。15 MHz 及以上的探头有利于检测微血管。根据与穿支血管成像相关的按钮、开关和特定屏幕选项，将标准 US 设备的旋钮学分为四个不同的组。为了对微血管进行定性和定量评估，测试了不同的 US 模式，以评估其有用性。CCDS 检查的重要元素分为安全识别穿支血管的三个关键步骤和进一步穿支血管特征化的三个可选步骤。应用了 CCDS 检查的标准化方案。降低脉冲重复频率/比例以适应设备对低速血流的敏感性是可视化微血管的最重要标准。使用 B 模式、CCDS、PD 模式和 B-Flow 模式进行定性微血管评估。使用 PW 模式和 CCDS 测量微血管直径（mm）和血流特征进行定量评估。可以使用 PW 模式和 CF 模式中的距离测量工具获得定量信息。
适当的设备调整和应用方面的技术因素对 CCDS 引导的穿支血管识别和评估有决定性影响。
