Kehrer, Andreas and Sachanadani, Neil S. and da Silva, Natascha Platz Batista and Lonic, Daniel and Heidekrueger, Paul and Taeger, Christian D. and Klein, Silvan and Jung, Ernst Michael and Prantl, Lukas and Hong, Joon-Pio (2020) Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - Basic and advanced applications and device settings. JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 73 (6). pp. 1081-1090. ISSN 1748-6815, 1878-0539
Full text not available from this repository. (Request a copy)Abstract
Background: The anterolateral thigh (ALT) perforator flap is a popular reconstructive tissue transfer. Consistent with the "hot/cold zone" concept for rapid dissection and thin flap harvest, reliable preoperative perforator mapping is mandatory. Color-coded duplex sonography (CCDS) has been shown to have the highest pooled sensitivity and positive predictive value to identify ALT perforating vessels. By reviewing this guide, the reader should learn: 1. Probe selection and basic/advanced device settings 2. Interpreting tissue morphology 3. Structured mapping approach 4. Pedicle position planning 5. Safe flap design 6. Assess subcutaneous course and flap's thickness for subfascial/epifascial/suprafascial harvest 7. Implement perforators identified into a tailor-made flap design including chimeric flaps. Methods: Experiences with ultrasound-guided flap design gained from 125 ALT perforator flap free tissue transfers performed in two reconstructive centers was the basis of our guide. Our structured method comprises standardized markings, patient positioning, and simple ergonomics. Basic and advanced CCDS settings, selection, and conventional probe guidance are outlined for the microsurgeon. Results: Linear multifrequency probes (6-15 MHz) were used. Best preset programs were breast, thyroid, and vascular. Favorable device properties were depth focused to 2-5 cm, pulse repetition frequency (PRF/Scale) set low to 0.5-1.5 kHz/3-10 cm/s, color gain high, and wall filter (WF) low/off (< 50 Hz). Additional parameters were discussed. A 100% concordance rate was seen comparing preoperative perforator visualization with CCDS and intraoperative findings. Detailed picture and video material were demonstrated. Conclusion: CCDS is a powerful tool for preoperative perforator mapping in perforator flaps such as the ALT. (c) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ANTEROLATERAL THIGH FLAP; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COLOR DOPPLER ULTRASOUND; PERFORATOR FLAP; CUTANEOUS PERFORATORS; PREOPERATIVE ASSESSMENT; DUPLEX ULTRASONOGRAPHY; DIAGNOSTIC EFFICACY; FEMORAL-ARTERY; RECONSTRUCTION; Plastic surgery; Reconstructive surgery; ALT flap; Perforator; Perforator mapping; Ultrasound; Sonography; Angiography; Color Duplex ultrasound; Color coded; Duplex sonography; Power Doppler; Flap design; Suprafascial harvest; Thin ALT flap |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Röntgendiagnostik Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Plastische-, Hand- und Wiederherstellungschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Mar 2021 08:34 |
| Last Modified: | 22 Mar 2021 08:34 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44441 |
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