From the Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S403-S407. doi: 10.1097/SAP.0000000000003546. Epub 2023 May 31.
Handheld Doppler is often inaccurate in localization of perforators for pedicled and free flaps. Color Doppler ultrasound (CDU), in contrast, allows more accurate mapping and characterization of perforators to facilitate rapid flap harvest.
Forty-seven flaps harvested from the lower extremity were evaluated preoperatively with CDU by a single surgeon with a conventional low-frequency ultrasound device (Philips Sparq, Cambridge, Mass). Flaps evaluated included profunda artery perforator flaps (n = 36), anterolateral thigh flaps (n = 2), pedicled propeller perforator flaps (n = 7), and toe transfers (n = 2).
In all cases where a free profunda artery perforator or anterolateral thigh flap was used, the location of the dominant perforator visualized preoperatively correlated exactly with intraoperative findings. In cases where CDU was used preoperatively to locate a large perforator close to a lower extremity defect for reconstruction with a propeller perforator flap, all perforators could be used, and all flaps were successful.
Preoperative CDU is particularly useful for flap planning where knowledge of the location of the dominant perforator is critical. This includes planning of thin and superthin free flaps, as well as freestyle perforator flaps. Our clinical experience suggests that this technology should be routinely adopted in certain aspects of reconstructive microsurgery.
手持式多普勒在定位皮瓣和游离皮瓣的穿支时往往不够准确。相比之下，彩色多普勒超声（CDU）可以更准确地绘制和描述穿支，有助于快速采集皮瓣。
由一位外科医生使用传统低频超声设备（Philips Sparq，马萨诸塞州剑桥）对 47 个来自下肢的皮瓣进行了术前 CDU 评估。评估的皮瓣包括股深动脉穿支皮瓣（n=36）、股前外侧皮瓣（n=2）、带蒂螺旋桨穿支皮瓣（n=7）和足趾转移（n=2）。
在所有使用游离股深动脉穿支或股前外侧皮瓣的情况下，术前可视化的优势穿支的位置与术中发现完全一致。在术前使用 CDU 定位靠近下肢缺损的大穿支以用螺旋桨穿支皮瓣重建的情况下，所有穿支均可使用，所有皮瓣均成功。
术前 CDU 对于需要了解优势穿支位置的皮瓣规划特别有用。这包括薄皮瓣和超薄皮瓣以及自由风格穿支皮瓣的规划。我们的临床经验表明，这项技术应在重建显微外科的某些方面常规采用。
