Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Goudot, Guillaume; Berkane, Yanis; Clermont-Tonnerre, Eloi de; Guinier, Claire; Reiterdank, Irina Filz von; Kampen, Antonia van; Uygun, Korkut; Cetrulo, Curtis L.; Uygun, Basak E.; Dua, Anahita; Lellouch, Alexandre G.

doi:10.3389/fphys.2022.1063240

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…These preliminary experiments showed us the importance of the initial flow value on resistance in the flaps, reflective of the microvasculature. Since each flap has its own specific vascular compliance and anatomy, we recommend an intra-operative ultrasound examination for each new flap model to confirm its quality and estimate the initial arterial rate [41]. Biochemical measurements indicated potential ischemia, even in flaps with no muscle.…”

Section: Discussionmentioning

confidence: 99%

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Berkane,

Lellouch,

Goudot

et al. 2023

Bioengineering

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Machine perfusion has developed rapidly since its first use in solid organ transplantation. Likewise, reconstructive surgery has kept pace, and ex vivo perfusion appears as a new trend in vascularized composite allotransplants preservation. In autologous reconstruction, fasciocutaneous flaps are now the gold standard due to their low morbidity (muscle sparing) and favorable functional and cosmetic results. However, failures still occasionally arise due to difficulties encountered with the vessels during free flap transfer. The development of machine perfusion procedures would make it possible to temporarily substitute or even avoid microsurgical anastomoses in certain complex cases. We performed oxygenated acellular sub-normothermic perfusions of fasciocutaneous flaps for 24 and 48 h in a porcine model and compared continuous and intermittent perfusion regimens. The monitored metrics included vascular resistance, edema, arteriovenous oxygen gas differentials, and metabolic parameters. A final histological assessment was performed. Porcine flaps which underwent successful oxygenated perfusion showed minimal or no signs of cell necrosis at the end of the perfusion. Intermittent perfusion allowed overall better results to be obtained at 24 h and extended perfusion duration. This work provides a strong foundation for further research and could lead to new and reliable reconstructive techniques.

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Section: Discussionmentioning

confidence: 99%

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Berkane,

Lellouch,

Goudot

et al. 2023

Bioengineering

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“…Other approaches, such as ischemic preconditioning, have been studied, but the lack of clinical studies makes it a scarce approach that needs further evidence [ 52 , 53 , 54 , 55 ]. One crucial consideration is the intraoperative mapping of the flaps, which can be accomplished using various technologies, such as indocyanine green (ICG) angiography [ 56 , 57 , 58 ] or evaluation through microvascular Doppler ultrasound [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction

Chrelias,

Berkane,

Rousson

et al. 2023

JCM

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Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed—12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.

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“…Currently, MFI has been used to evaluate the microcirculation of superficial space-occupying lesions, muscle, joint ligament related diseases, improving the ability of US diagnosis and assessment, such as breast, carpal tunnel syndrome, and so on ( 14 , 15 ). It can also be applied to arterial plaque stability prediction, liver disease blood perfusion evaluation, chronic kidney allograft damage, and other aspects ( 16 - 19 ). MFI is a technique that can suppress the low-speed clutter caused by tissue movement and can be used to detect the lower-speed and finer blood-flow signals than those detected by color, power, and spectral Doppler, which lowers the necessity of subsequent contrast-enhanced US (CEUS) ( 20 - 22 ).…”

Section: Introductionmentioning

confidence: 99%

Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique

Lu,

Sun,

Zhang

et al. 2024

Quant Imaging Med Surg

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Background MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I–II membranous nephropathy (MN). Methods Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05. Results VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89–0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79–0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64–0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43–0.84). Conclusions MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.

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Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Cited by 4 publications

References 19 publications

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction

Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique

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