Quantitative Assessment of Bone Microvascularization After Osteocutaneous Flap Transplantation Using Contrast-Enhanced Ultrasound (CEUS)

Abstract

CEUS seems to be capable of detecting vascular disturbances and of assessing microvascularization of the osseous component after osteocutaneous flap transplantation.

Current Evidence for Postoperative Monitoring of Microvascular Free Flaps

“…182 One of the major advantages of CEUS is that it provides both qualitative assessment of the capillary perfusion in different flap areas and quantitative analysis using parameters derived from a special perfusion software QONTRAST (Bracco, Italy), such as time to PEAK and regional blood volume. 183,184 Furthermore, Sharma et al 185 demonstrated that both qualitative and quantitative assessments by CEUS are associated with high sensitivity (100% and 100%, respectively) and specificity (86% and 100%) in predicting flap failure. In a recent retrospective analysis, Geis et al 186 demonstrated that vascular complications estimated by QONTRAST and CEUS produced a high flap salvage rate of 85%.…”

Studies of Superb Microvascular Imaging and Contrast‐Enhanced Ultrasonography in the Evaluation of Vascularization in Early Bone Regeneration

“…Contrast‐enhanced ultrasonography can dynamically display vascularity in organs using ultrasound contrast agents. Because CEUS can clearly show the neovascular vessels in the graft bone, it is a popular method for detecting neovascularization . The application of CEUS in fracture healing has been gradually tried and accepted.…”

“…Because CEUS can clearly show the neovascular vessels in the graft bone, it is a popular method for detecting neovascularization. 17 The application of CEUS in fracture healing has been gradually tried and accepted. Krammer et al 18 reported that early evaluation (examination at 12 week) of successful recovery after tibial non-union can be realized with CEUS.…”

Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software

“…Assessment of microcirculation can be performed without any restrictions at least up to a penetration depth of 6 cm using high-resolution linear probes. Based on these unique properties, several studies on over 100 patients have been conducted over the last few years in order to thoroughly assess flap microcirculation [13,14]. Unfortunately, the assessment of flap perfusion requires data extraction and calculation on a personal computer.…”

“…The contrast-enhanced ultrasound (CEUS) examination setup was similar to previous studies of our group [13,14] and can be briefly summarised as follows: one experienced examiner (qualified by performing more than 5 000 ultrasound examinations per year) conducted the ultrasound examination using a multiple-frequency linear probe enabling high-resolution contrastenhanced ultrasound examination (6-9 MHz, LOGIQ E9/GE). After a bolus injection of 1-2.4 ml sulphur hexafluoride micro bubbles (SonoVue ® , Bracco, Italy) through a cubital vein, 10 ml NaCl was applied to enable data acquisition in True Agent detection mode simultaneously in CEUS and B-scan mode.…”