A single‐center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times

Abstract

Introduction:We reported on the superiority of preoperative Duplex mapping ("Duplex") over audible Dopplers ("Doppler") in anterolateral thigh perforator (ALT) free flaps for upper extremity reconstruction. To corroborate our findings on a larger cohort, we conducted this present study focusing on surgical efficiency and patient safety.Methods: 150 consecutive ALT free flaps were divided into 65 cases of preoperative Duplex versus 85 Doppler controls. We first compared patient demographics, operative details, and defect and flap characteristics. We then assessed group differences in the number and course of perforators pursued intraoperatively, flap harvest and operative times, and donor-site complications. Additionally, the impact of the training level of the primary microsurgeon was evaluated.Results: Cases and controls were comparable regarding age (p = .48), sex (p = .81), ASA class (p = .48), and BMI (p = .90). Duplex was associated with an increased likelihood of raising flaps on one single dominant perforator of purely septal course and significant reductions of flap harvest (68 ± 10 min, p < .0001) and operative times (74 ± 16 min, p < .0001), regardless of the experience of the primary microsurgeon. There were strong negative linear correlations between preoperative Duplex and both the flap harvest and operative times (p < .0001). Additionally, while there was no effect on the emergency take-back rate (OR = 1.3, p = .60), revisions were significantly less likely among duplexed patients (OR = 0.15, p = .04).Conclusions: Preoperative Duplex is associated with a significant reduction in ALT free flap harvest and overall operative times, as well as donor-site revisions as opposed to Doppler planning, regardless of the training level of the primary microsurgeon. | INTRODUCTIONFlap loss and necrosis, as well as overall microsurgical complication rates of have been steadily decreasing (Carney et al., 2018). However, with the outcomes of microsurgery becoming more reliable and the number of free flaps constantly growing, efforts are increasingly shifting toward improving surgical efficacy as well as patient safety (Schmauss et al., 2019). Among a plethora of perioperative aspects,

High‐frequency ultrasound‐assisted perforator mapping enhances efficiency in microsurgical reconstruction using thin ALT and SCIP flaps

“…By providing detailed information on perforator location and course, surgeons can proceed with the operation within the predicted range, potentially reducing the time required for flap elevation. Our findings can be interpreted in the context of previous studies (Thomas et al, 2020; Thomas et al, 2022).…”

Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels—A proof‐of‐concept and cross‐sectional study

“…A comparable preoperative use of the investigated Doppler transducer to detect certain blood vessels had been reported in the field of reconstructive antero-lateral thigh flap surgery in several T A B L E 2 Mean and median distances between the centre of the detected signal and the gingival margin on the right side. studies (Cheng et al, 2012;Lethaus et al, 2017;Thomas et al, 2020Thomas et al, , 2022. We found that it was possible to detect a clear arterial pulse signal in at least 80%-90% of all measurements within the clinically most relevant palatine molar and premolar regions.…”

“…As an example, in the context of surgical interventions, Doppler techniques are commonly used in thigh‐flap surgery. In particular, the preoperative detection of perforating blood vessels in antero‐lateral thigh‐flap surgery has been reported in multiple studies (Cheng et al, 2012; Lethaus et al, 2017; Thomas et al, 2020, 2022). In these studies, both colour‐coded duplex ultrasonography and an 8‐MHz handheld DUS transducer were successfully used.…”

Development of a mathematical formula and online tool to calculate the potential maximum flap width to allow for primary anterolateral thigh donor‐site closure in Caucasians

“…Prior to surgery, ALT perforator mapping was performed by marking and scanning both thighs on the eve of operation as described elsewhere (Thomas et al, 2020; Thomas, Haug, et al, 2021): in brief, anatomic landmarks were identified, including the intermuscular septum between the anterior superior iliac spine and superolateral patella. At its midpoint, suitable perforators were then located and marked by using either unidirectional audible Doppler probes or linear multifrequency transducers with overlaid B‐ and Color‐Flow‐modes.…”