An overview of methods for vascular mapping in the planning of free flaps

Smit, Jeroen M.; Klein, Steven; Werker, Paul M. N.

doi:10.1016/j.bjps.2010.06.013

Cited by 114 publications

(108 citation statements)

References 74 publications

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“…To assess the validity, Color Doppler sonography (iU22 Duplex with a L17-5 transducer, Philips, Eindhoven, The Netherlands) was used as standard for comparison, which has been succesfully used to preoperatively assess the vascularization of flaps for reconstructions in the head and neck, trunk and extremitites [8]. The same vascular laboratory technician mapped the perforators within the same squares described.…”

Section: Color Doppler Sonography (Duplex)mentioning

confidence: 99%

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The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get

Stekelenburg

Sonneveld

Bouman

et al. 2014

Burns

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Section: Color Doppler Sonography (Duplex)mentioning

confidence: 99%

“…In the past many years, several advanced diagnostic tools have become available, such as Magnetic Resonance Imaging, Computed Tomography Angiography, Digital Subtraction Angiography and Color Doppler Sonography (Duplex) [8]. These techniques have proven to accurately detect perforator locations.…”

Section: Introductionmentioning

confidence: 99%

The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get

Stekelenburg

Sonneveld

Bouman

et al. 2014

Burns

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“…The virtually infinite number of potential donor sites, with a highly variable vascular anatomy, requires preoperative visualization and mapping of perforators [13]. Preoperative perforator mapping optimizes flap design, reduces operating time and has become standard in certain areas of reconstructive surgery, such as breast reconstruction [5,[14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

et al. 2015

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Aims: The high technical demands associated with perforator flaps demand a precise preoperative identification and evaluation of perforator vessels. Color Doppler Ultrasonography (CDU) and Dynamic Infrared Thermography (DIRT) are currently used for preoperative perforator mapping. Each individual technique has advantages and disadvantages. The purpose of this paper is to analyze the value of combining the two methods in order to optimize the process of preoperative perforator mapping. Material and methods: CDU and DIRT were used for preoperative perforator mapping in 10 pigs. The results were compared to intraoperative findings. Total number of perforators, localization, and identification of the dominant perforator was analyzed for each method. The examination time was recorded for each procedure. Results: Both methods had a high sensitivity in determining the number and localization of perforators when compared to those identified during surgery. DIRT produced a higher number of false positive results. CDU accurately identified the emergence of the perforators in the fascia in all cases. Both methods correctly identified the dominant perforator. The sensitivity, positive predictive value, and accuracy of CDU were 93.56%, 97%, and 91.30% respectively and for DIRT 95.05%, 80.67%, and 77.41% respectively. The average examination was 39.76 minutes for CDU and 10.24 minutes for DIRT. The average time taken into account for the analysis of a single perforator in order to confirm DIRT findings was 1.83 minutes. Conclusions: Preoperative perforator mapping has become a compulsory step in nearly all reconstructive procedures. In our study, both CDU and DIRT correctly identified the dominant perforator in all cases. By combining the two examinations overall mapping time can be reduced significantly. A reduced examination time translates into increased patient compliance and a lower procedure cost. The combined mapping technique facilitates the selection of the ideal perforator in all cases. Correctly identifying the dominant perforator preoperatively reduces operative time, lowers complication rates and ensures an overall better result.

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“…Color Doppler sonography has advantage that it can be used in real time. 2 However, with regard to harvest of perforator flap, it is usually used for preoperative assessment, not for intraoperative detection of perforators in real time.…”

mentioning

confidence: 99%

Intraoperative color Doppler sonography in the elevation of anterolateral thigh flap

et al. 2011

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There are currently multiple imaging techniques available for planning perforator flap harvest. Some studies demonstrated the superiority of computed tomographic angiography (CTA) over the other options for the preoperative mapping in the perforator flaps because it could evaluate the perforators more precisely.1 Nevertheless, CTA has a disadvantage that it cannot be used in real time and provide real-time feedback during harvesting flap. Color Doppler sonography is another effective tool for surgical planning. Color Doppler sonography has advantage that it can be used in real time.2 However, with regard to harvest of perforator flap, it is usually used for preoperative assessment, not for intraoperative detection of perforators in real time.Between April and November 2010, we have performed intraoperative color Doppler sonography in real-time use during anterolateral thigh (ALT) flap harvest in eight patients. Preoperatively, the locations of cutaneous perforators were evaluated, using color Doppler sonography with a 12-MHz linear probe. Perioperatively, according to the preoperative assessment, the longitudinal incision line was designed in the middle of the anterior thigh. An incision was made and extended down through the fascia of the rectus femoris. The cut end of the deep fascia of the vastus lateralis was grasped with several clamps and retracted laterally. We carefully dissected between the fascia and the underlying muscle, and cutaneous perforator could be found. We then looked for the intermuscular septum between vastus lateralis and rectus femoris. Having defined the septum, we explored the septum with finger dissection to expose the full extent of the descending branch of the lateral circumflex femoral artery and the origin of perforating vessels. We prepared color Doppler sonography when the perforators were identified with a myocutaneous type. The probe was placed directly on to the surface of the vastus lateralis, and intramuscular perforator could be visualized by color mode (Fig. 1). The course and depth of the intramuscular perforator could be identified, and we marked the dissecting line on the surface of vastus lateralis (Fig. 2). We then begun to dissect out the perforators according to the intraoperative color Doppler sonography assessment and elevated the flap. In all cases, intramuscular perforators were detected by intraoperative color Doppler sonography and the flaps could be harvested safely.There are two key steps involved in elevating ALT flap. The first step is to locate the cutaneous perforators at the subfascial level, and the second is to follow these perforators to their main pedicle.3 Therefore, knowledge about anatomic variation of the vessel and information regarding the distribution of the perforators might be required in elevating the ALT flap. Many studies have discussed anatomical variations of the descending branch of lateral circumflex pedicle and the relationships between the lateral circumflex femoral pedicle and perforators. 3,4 But the perforator anatomy of

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An overview of methods for vascular mapping in the planning of free flaps

Cited by 114 publications

References 74 publications

The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get

The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

Intraoperative color Doppler sonography in the elevation of anterolateral thigh flap

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