Mueller, S. and Gosau, M. and Wendl, C. M. and Prantl, L. and Wiggermann, P. and Reichert, T. E. and Jung, E. M. (2012) Postoperative evaluation of microvascularization in mandibular reconstructions with microvascular flaps - First results with a new perfusion software for contrast-enhanced sonography (CEUS). CLINICAL HEMORHEOLOGY AND MICROCIRCULATION, 52 (2-4). pp. 187-196. ISSN 1386-0291,
Full text not available from this repository. (Request a copy)Abstract
Purpose: Quantitative measurement of dynamic contrast values obtained by contrast-enhanced ultrasound (CEUS) for evaluating microvascularization in osseous and osseocutaneous free flaps used for maxillofacial reconstructions. Patients and Methods: 22 patients (6 women, 16 men, mean age: 57 years, range: 47 to 82 years) who had received mandibular reconstructions with 3 avascular and 19 microvascular free osseous or osseocutaneous transplants were included in this trial. 16 patients had received a microvascular osseocutaneous fibular flap, 2 patients a microvascular osseous fibular flap and 1 patient a microvascular osseous iliac crest flap. Patients were followed up for 12 months on average (range: 3 to 20 months). Ultrasound examination was carried out by one experienced examiner with a linear probe (6-9 MHz, LOGIQ E9, GE) after the intravenous bolus injection of 2.4 ml contrast agent (SonoVue (R), BRACCO, Germany). Digital cine loops were analysed with a quantification software (VueBox (TM)) for determining wash-in parameters: Rise Time (RT), Peak Enhancement (PE), Wash-in Area Under the Curve (WiAUC) and Wash-in Rate (WiR). Results were compared with the patients' postoperative clinical outcome. Results: For the bone area the median of the RT was 10.0 s (range 3.1 to 65.0 s), for the ratio between bone tissue and soft tissue for the PE the median was 10.4% (range 2.6 to 29.8%), the median for the WiAUC was 11.1% (range 1.5 to 77.7%) and the median for the WiR was 5.7 % (range 0.7 to 61.1%). None of the patients with microvascular osseocutaneous and osseous flaps showed any signs of transplant bone loss, which corresponded with the qualitative CEUS assessment. The patients with microvascular re-anastomosed transplants showed widely varying values for the investigated parameters (RT, PE, WiAUC, WiR). For patients with avascular bone transplants, these parameters were reduced to zero values for the bone area resulting in a significant difference (p < 0.05) for the PE compared to the patients with microvascular bone transplants. Conclusion: CEUS allowed the qualitative assessment of bone microvascularization by observing the transition of the contrast agent from the periostal area into the bone. However, defining a critical lower border by quantification of bone perfusion was difficult because of the inconstant perfusion of the bone transplants used in the trial.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FREE TISSUE TRANSFER; ULTRASOUND CEUS; BONE-SCINTIGRAPHY; QUANTITATIVE-EVALUATION; TIC ANALYSIS; IMAGING CHI; MICROCIRCULATION; EXPERIENCE; VIABILITY; ULTRASONOGRAPHY; Osseous flaps; osseocutaneous flaps; contrast-enhanced ultrasound; perfusion quantification |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Mund-, Kiefer- und Gesichtschirurgie Medicine > Lehrstuhl für Röntgendiagnostik Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Plastische-, Hand- und Wiederherstellungschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 May 2020 08:16 |
| Last Modified: | 22 May 2020 08:16 |
| URI: | https://pred.uni-regensburg.de/id/eprint/19412 |
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