Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU)

Abstract

Background The first reports of using color Doppler ultrasound for evaluation of the microvasculature were in the 1990s. Despite the early reports of its efficacy, color Doppler ultrasound did not achieve popularity nor general usage in part due to the cumbersome size, cost and poor resolution. This is the first study to demonstrate the potential utility of a new, highly portable, tablet-based color Doppler ultrasound (PT-CDU) system for imaging perforator flaps. Methods The deep inferior epigastric artery (DIEP), lateral arm (LA), anterolateral thigh (ALT), thoracodorsal artery (TDAP), and the medial sural artery (MSAP) perforator flaps were imaged within classic topographic landmarks to visualize and measure variables related to perforator flap anatomy. The Philips Lumify L12–4 linear array probe attached to the Samsung Galaxy Tab A tablet was the system used for all examinations. Results A total of 216 flaps were scanned in 50 healthy adult volunteers: 44 DIEP, 44 LA, 40 ALT, 48 TDAP, and 40 MSAP. Precise anatomic information regarding perforator size, number, and location was obtained. Overall, the percent of flaps having at least 1 perforator within the specified topographical landmarks was 89% for the DIEP, 84.1% for the LA, 72.5% for the ALT, 50% for the TDAP, and 30% for the MSAP (p = 2.272e-09). The percent of patients having an asymmetry (right versus left) in the number of perforators was 72.7% (ALT), 65% (DIEP), 59.1% (LA), 41.7% (TDAP), and 30% (MSAP) (p = 0.0351). Conclusions Portable, tablet-based color Doppler ultrasound offers high-resolution images of perforators and represents a facile technology that may be of interest to microsurgeons in the planning of perforator flaps. Variations in vascular anatomy were well-demonstrated. This surgeon-driven imaging technology may represent an excellent alternative to other imaging modalities.

Perforator Characteristics and Impact on Postoperative Outcomes in DIEP Flap Breast Reconstruction: A Systematic Review and Meta-Analysis

“…39 While preoperative imaging allows for vascular mapping and better understanding of perforator anatomy, we do not recommend it routinely. [40][41][42] Instead, it adds an additional procedure for the patient and an inconvenience factor especially since a large portion of breast reconstructions are done in an ambulatory surgery center, in which case the imaging would have to be done elsewhere first. Furthermore, increased BMI also limits CTA for presurgical planning due to decreased visualization of perforators with increased body weight.…”

Imaging in reconstructive microsurgery – current standards and latest trends

“…The use of color Doppler ultrasound in perforator surgery has first been reported in the 1990s and has gained in popularity when devices have become smaller and the imaging technique has improved over time. Nowadays it is possible to obtain high resolution images of vessels and their distal topography [ 5 ]. In addition, when using contrast-enhanced ultrasound, further information such as blood-flow patterns and velocity can be obtained and even 3D reconstructions of donor sites are possible [ 6 ].…”

The Thoracodorsal Artery Perforator Flap: A Powerful Tool in Breast Reconstruction

“…6 In addition, palpable topographic landmarks may not correlate to the locations of intermuscular or fascial planes. 7 These concerns also apply to other perforator flaps.A plethora of studies have emerged over the past several years highlighting the utility of surgeon-led high-resolution ultrasound, whether tablet-based or traditional cart-based, in the imaging of perforators, their course, their flow velocity, and their size. 8,9 In addition, muscular fascial planes and underlying parent vessels can be identified.…”

“…6 In addition, palpable topographic landmarks may not correlate to the locations of intermuscular or fascial planes. 7 These concerns also apply to other perforator flaps.…”