Thoracic dorsal artery perforating flap transplantation under high-frequency ultrasound guidance

doi:10.3969/j.issn.2095-4344.2014.38.013

Abstract

Abstract:

BACKGROUND: The most advanced and representative diagnosis techniques for perforating branch of blood vessels include digital subtraction angiography, CT, MRI and other imaging techniques. These methods can visualize blood vessels clearly and have a high precision, but there are some trauma and less popular.
OBJECTIVE: To apply high-frequency ultrasound for detection of thoracic dorsal artery and perforating branch, and provide a reference for preoperative design of thoracic dorsal artery perforating flap.
METHODS: Fifteen patients candidate for thoracic dorsal artery perforating flap were included in this study. Before surgery, we used high-frequency ultrasound to detect the perforating branch, including vascular contorts, diameter, the location of the perforators and surface markers. The thick, superficial, parallel perforating branch was selected as the main blood vessels, to design and cur the skin flap.
RESULTS AND CONCLUSION: In the involved 15 cases, thoracic dorsal artery were derived from the subscapular artery, thoracic dorsal artery and its main branches, as well as more than 1 mm main perforating branch in 13 cases were clearly visible. It was consistent with intraoperative measurement results. The perforating branch less than 1 mm only showed strip-like blood flow signal or no blood flow and spectrum signal,
and there was an unclear boundary to surrounding tissue. One case appeared distortion and variation of blood vessels before surgery, thus changed to other surgery. Two cases had no perforating branch by preoperative detection, which was then confirmed by intraoperative anatomy. High-frequency ultrasound has a significant effect on preoperative position of perforating branch, and the combination with computer tomography angiography and magnetic resonance angiography can support a more comprehensive and reliable reference.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: ultrasonography, surgical flaps, thoracic arteries, hemodynamics

CLC Number:

R318

Shen Mei-hua, Alimujiang Abulaiti, Aihemaitijiang Yushufu, Dong Jian, Wang Wei, Liu Ya-fei. Thoracic dorsal artery perforating flap transplantation under high-frequency ultrasound guidance[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(38): 6141-6145.

Figures/Tables 1

References

[1] 唐玉举.特殊形式穿支皮瓣的临床应用教程[J].中华显微外科杂志,2013,36(2):201-205.
[2] Hamdi M, Decorte T, Demuynck M, et al.Shoulder function after harvesting a thoracodorsal artery perforator flap.Plast Reconstr Surg. 2008;122(4):1111-1117.
[3] Schaverien M, Wong C, Bailey S,et al.Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap--anatomical study of the constant skin paddle perforator locations.J Plast Reconstr Aesthet Surg. 2010;63(12): 2123-2127.
[4] Koshima I, Narushima M, Mihara M,et al.New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb.J Plast Reconstr Aesthet Surg. 2010;63(1):140-145.
[5] Sever C, Uygur F, Kulahci Y,et al.Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects.Indian J Plast Surg. 2012;45(3):478-484.
[6] Amin AA, Rifaat M, Ellabban MA,et al.Transaxillary thoracodorsal artery perforator flap: a versatile new technique for hypopharyngeal reconstruction.J Reconstr Microsurg. 2014; 30(6):397-404.
[7] Pacifico MD, See MS, Cavale N,et al.Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation.J Plast Reconstr Aesthet Surg. 2009;62(11):1464-1469.
[8] Zou Z, Kate Lee H, Levine JL,et al.Gadofosveset trisodium-enhanced abdominal perforator MRA.J Magn Reson Imaging. 2012;35(3):711-716.
[9] Saba L, Atzeni M, Rozen WM,et al.Non-invasive vascular imaging in perforator flap surgery.Acta Radiol. 2013;54(1): 89-98.
[10] Gravvanis A, Tsoutsos D, Papanikolaou G,et al.Refining perforator selection for deep inferior epigastric perforator flap: the impact of the dominant venous perforator.Microsurgery. 2014;34(3):169-176.
[11] Pestana IA, Zenn MR.Correlation between abdominal perforator vessels identified with preoperative CT angiography and intraoperative fluorescent angiography in the microsurgical breast reconstruction patient.Ann Plast Surg. 2014;72(6):S144-149.
[12] Schaverien M, Saint-Cyr M, Arbique G,et al.Three- and four-dimensional arterial and venous anatomies of the thoracodorsal artery perforator flap.Plast Reconstr Surg. 2008; 121(5):1578-1587.
[13] Schaverien M, Wong C, Bailey S,et al.Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap--anatomical study of the constant skin paddle perforator locations.J Plast Reconstr Aesthet Surg. 2010;63(12): 2123-2127.
[14] 农剑波,李耀波,王宇飞,等.CTA、MRA、DSA在头颈部动脉瘤诊断的应用[J].中国当代医药,2012,19(7):99,101.
[15] Hoi Y, Ionita CN, Tranquebar RV,et al.Flow modification in canine intracranial aneurysm model by an asymmetric stent: studies using digital subtraction angiography (DSA) and image-based computational fluid dynamics (CFD) analyses.Proc Soc Photo Opt Instrum Eng. 2006;6143:61430.
[16] Rozen WM, Phillips TJ, Ashton MW, et al. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and doppler ultrasound. Plast Reconstr Surg. 2008;121(1 Suppl):1-8.
[17] Scott JR, Liu D, Said H,et al.Computed tomographic angiography in planning abdomen-based microsurgical breast reconstruction: a comparison with color duplex ultrasound.Plast Reconstr Surg. 2010;125(2):446-453.
[18] Zou Z, Kate Lee H, Levine JL,et al.Gadofosveset trisodium-enhanced abdominal perforator MRA.J Magn Reson Imaging. 2012;35(3):711-716.
[19] Kosutic D, Pejkovic B, Anderhuber F,et al.Complete mapping of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation.J Plast Reconstr Aesthet Surg. 2012;65(11):1530-1536.
[20] Lin CT, Huang JS, Hsu KC,et al.Different types of suprafascial courses in thoracodorsal artery skin perforators.Plast Reconstr Surg. 2008;121(3):840-848.
[21] Lin CT, Huang JS, Yang KC,et al.Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap.Plast Reconstr Surg. 2006;118(6):1376-1386.
[22] Xiao H, Shi Y, Wang H,et al.Application of high frequency color Doppler ultrasound in anterolateral thigh flap surgery.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013; 27(2):178-181.
[23] 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.
[24] 陆林国,徐智章,刘吉斌,等.超声造影增强技术在探索穿支皮瓣血管中的应用[J].上海医学影像,2010,19(3):161-164.