A comparative study of color Doppler ultrasound and CT angiography for preoperative evaluation of perforator vessels in free posterior interosseous artery flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hongquan ¹ , LIU Shanshan ² , XIE Yingzhi ¹ , HU Haoliang ^3,4 ,  LI Miaozhong ^3,4

1. Department of Radiology, Ningbo Sixth Hospital, Ningbo Zhejiang, 315040, P. R. China;
2. Department of Ultrasound, Ningbo Sixth Hospital, Ningbo Zhejiang, 315040, P. R. China;
3. Department of Hand Surgery, Ningbo Sixth Hospital, Ningbo Zhejiang, 315040, P. R. China;
4. Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo Zhejiang, 315040, P. R. China;

Corresponding author：

LI Miaozhong, Email: 465713434@qq.com

Keywords：

Perforator flap; posterior interosseous artery; color Doppler ultrasound; CT angiography

DOI：

10.7507/1002-1892.202502004

Video：

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Objective To investigate the accuracy of color Doppler ultrasound (CDU) and CT angiography (CTA) in the preoperative evaluation of perforator vessels in free posterior interosseous artery perforator (PIAP) flaps. Methods Between January 2020 and December 2023, 19 patients with hand skin and soft tissue defects caused by trauma were admitted. There were 11 males and 8 females, with a median age of 45 years (range, 26-54 years). The interval between injury and admission was 5-11 days (mean, 7.2 days). The skin and soft tissue defects were located on the dorsum of the hand in 8 cases and on the fingers in 11 cases; The size of defect ranged from 7.5 cm×3.5 cm-4.0 cm×2.5 cm. After locating the perforator vessels through CDU and CTA before operation, the free PIAP flaps were designed to repair hand defects, with the size of 7.5 cm×4.0 cm-4.5 cm×3.0 cm. The defects of donor sites were directly sutured. The number and diameter of perforator vessels in the posterior interosseous artery detected by CDU and CTA were compared. The differences in localization of perforator vessels using CDU and CTA and their clinical effects were also compared to calculate the accuracy and recognition rate. During follow-up, the survival of the skin flap was observed, and the Vancouver scar scale (VSS) was used to evaluate the healing of the donor site, while the visual analogue scale (VSA) score was used to evaluate the patient’s satisfaction with the appearance of the skin flap. Results The number and the diameter of PIAP vessels was 5.8±1.2 and (0.62±0.08) mm assessed by CDU and 5.2±1.0 and (0.60±0.07) mm by CTA, showing no significant difference between the two methods (P>0.05). The number, course, and distribution of perforator vessels of the PIAP vessels observed during operation were basically consistent with those detected by preoperative CDU and CTA. Compared with intraoperative observation results, the recognition rates of dominant perforating vessels by CDU and CTA were 95.0% (18/19) and 89.5% (17/19), respectively, and the accuracy rates were 100% (19/19) and 84.2% (16/19), with no significant difference between the two methods (P>0.05). All flaps survived after operation, and all wounds and incisions at donor sites healed by first intention. All patients were followed up 6-13 months (mean, 8.2 months). At last follow-up, the skin flaps had elasticity and soft texture, with the patient satisfaction VAS score of 9.21±0.81. The donor sites had no obvious scar hyperplasia with the VSS score of 11.68±0.93. Conclusion CDU and CTA accurately identify the dominant perforator vessels and provide reliable information for vessel localization, facilitating precise flap harvesting and minimizing donor site injury. However, CDU offers superior visualization of distal end of perforator vessels in the forearm compared to CTA.

1.	胡浩良, 王欣, 陈宏, 等. 吻合浅静脉的游离前臂骨间后动脉穿支皮瓣修复手背皮肤缺损. 中华显微外科杂志, 2012, 35(3): 224-225.
2.	王欣, 潘佳栋, 陈宏, 等. 骨间后动脉近端穿支皮瓣游离移植修复手部软组织缺损. 中华整形外科杂志, 2012, 28(2): 83-87.
3.	González Martínez J, Torres Pérez A, Gijón Vega M, et al. Preoperative vascular planning of free flaps: comparative study of computed tomographic angiography, color Doppler ultrasonography, and hand-held Doppler. Plast Reconstr Surg, 2020, 146(2): 227-237.
4.	Dnäis DVI, Borivoj G, David B, et al. Preoperative planning using virtual reality and computed tomography angiogram in deep inferior epigastric perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2023, 87: 161-169.
5.	Katharina F, Armin S, Ingo L, et al. Improving the safety of DIEP flap transplantation: detailed perforator anatomy study using preoperative CTA. J Pers Med, 2022, 12(5): 701. doi: 10.3390/jpm12050701.
6.	Tabrez S, Frederic P, Alain R, et al. Best choice of perforator vessel in autologous breast reconstruction: Virtual reality navigation vs radiologist analysis. A prospective study. J Plast Surg Hand Surg, 2015, 49(6): 333-338.
7.	Fisnik J, Pranvera I, Elias J, et al. Atherosclerotic calcification detection: a comparative study of carotid ultrasound and cone beam CT. Int J Mol Sci, 2015, 16(8): 19978-19988.
8.	Bajus A, Streit L, Kubek T, et al. Color Doppler ultrasound versus CT angiography for diep flap planning: a randomized controlled trial. J Plast Reconstr Aesthet Surg, 2023, 86: 48-57.
9.	何少波, 刘继超, 李伍建, 等. 增强现实技术在胫后动脉穿支皮瓣修复下肢软组织缺损中的应用. 中国修复重建外科杂志, 2023, 37(2): 185-188.
10.	Faulx MD, Wright AT, Hoit BD. Detection of endothelial dysfunction with brachial artery ultrasound scanning. Am Heart J, 2003, 145(6): 943-51.
11.	van Heumen S, Riksen JJM, Bramer WM, et al. Imaging of the lymphatic vessels for surgical planning: A systematic review. Ann Surg Oncol, 2023, 30(1): 462-479.
12.	Hayashi A, Hayashi N, Yoshimatsu H, et al. Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol, 2018, 117(2): 290-298.
13.	Su W, Lu L, Lazzeri D, et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg, 2013, 131(1): 80-93.
14.	肖栋超, 竺枫, 李俊杰, 等. 不同位置动脉超灌注与静脉超引流对大鼠三跨区皮瓣成活的影响. 现代实用医学, 2022, 34(7): 849-852.
15.	Chim H, Sullivan B. The use of conventional lower-frequency color Doppler ultrasound for flap planning in the lower extremity. Ann Plast Surg, 2023, 90(6S Suppl 4): S403-S407.
16.	Bajus A, Kubek T, Dražan L, et al. Surgeon-conducted color Doppler ultrasound deep inferior epigastric artery perforator mapping: A cohort study and learning curve assessment. J Plast Reconstr Aesthet Surg, 2023, 76: 105-112.
17.	赵书明, 刘娜, 刘学亮, 等. 彩色多普勒超声辅助下超薄胸背动脉穿支皮瓣的切取方案及临床应用效果. 中华烧伤与创面修复杂志, 2024, 40(3): 281-288.
18.	Chim H. Perforator mapping and clinical experience with the superthin profunda artery perforator flap for reconstruction in the upper and lower extremities. J Plast Reconstr Aesthet Surg, 2023, 81: 60-67.

1. 胡浩良, 王欣, 陈宏, 等. 吻合浅静脉的游离前臂骨间后动脉穿支皮瓣修复手背皮肤缺损. 中华显微外科杂志, 2012, 35(3): 224-225.
2. 王欣, 潘佳栋, 陈宏, 等. 骨间后动脉近端穿支皮瓣游离移植修复手部软组织缺损. 中华整形外科杂志, 2012, 28(2): 83-87.
3. González Martínez J, Torres Pérez A, Gijón Vega M, et al. Preoperative vascular planning of free flaps: comparative study of computed tomographic angiography, color Doppler ultrasonography, and hand-held Doppler. Plast Reconstr Surg, 2020, 146(2): 227-237.
4. Dnäis DVI, Borivoj G, David B, et al. Preoperative planning using virtual reality and computed tomography angiogram in deep inferior epigastric perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2023, 87: 161-169.
5. Katharina F, Armin S, Ingo L, et al. Improving the safety of DIEP flap transplantation: detailed perforator anatomy study using preoperative CTA. J Pers Med, 2022, 12(5): 701. doi: 10.3390/jpm12050701.
6. Tabrez S, Frederic P, Alain R, et al. Best choice of perforator vessel in autologous breast reconstruction: Virtual reality navigation vs radiologist analysis. A prospective study. J Plast Surg Hand Surg, 2015, 49(6): 333-338.
7. Fisnik J, Pranvera I, Elias J, et al. Atherosclerotic calcification detection: a comparative study of carotid ultrasound and cone beam CT. Int J Mol Sci, 2015, 16(8): 19978-19988.
8. Bajus A, Streit L, Kubek T, et al. Color Doppler ultrasound versus CT angiography for diep flap planning: a randomized controlled trial. J Plast Reconstr Aesthet Surg, 2023, 86: 48-57.
9. 何少波, 刘继超, 李伍建, 等. 增强现实技术在胫后动脉穿支皮瓣修复下肢软组织缺损中的应用. 中国修复重建外科杂志, 2023, 37(2): 185-188.
10. Faulx MD, Wright AT, Hoit BD. Detection of endothelial dysfunction with brachial artery ultrasound scanning. Am Heart J, 2003, 145(6): 943-51.
11. van Heumen S, Riksen JJM, Bramer WM, et al. Imaging of the lymphatic vessels for surgical planning: A systematic review. Ann Surg Oncol, 2023, 30(1): 462-479.
12. Hayashi A, Hayashi N, Yoshimatsu H, et al. Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol, 2018, 117(2): 290-298.
13. Su W, Lu L, Lazzeri D, et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg, 2013, 131(1): 80-93.
14. 肖栋超, 竺枫, 李俊杰, 等. 不同位置动脉超灌注与静脉超引流对大鼠三跨区皮瓣成活的影响. 现代实用医学, 2022, 34(7): 849-852.
15. Chim H, Sullivan B. The use of conventional lower-frequency color Doppler ultrasound for flap planning in the lower extremity. Ann Plast Surg, 2023, 90(6S Suppl 4): S403-S407.
16. Bajus A, Kubek T, Dražan L, et al. Surgeon-conducted color Doppler ultrasound deep inferior epigastric artery perforator mapping: A cohort study and learning curve assessment. J Plast Reconstr Aesthet Surg, 2023, 76: 105-112.
17. 赵书明, 刘娜, 刘学亮, 等. 彩色多普勒超声辅助下超薄胸背动脉穿支皮瓣的切取方案及临床应用效果. 中华烧伤与创面修复杂志, 2024, 40(3): 281-288.
18. Chim H. Perforator mapping and clinical experience with the superthin profunda artery perforator flap for reconstruction in the upper and lower extremities. J Plast Reconstr Aesthet Surg, 2023, 81: 60-67.

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