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J Reconstr Microsurg 2022; 38(03): 181-192
DOI: 10.1055/s-0041-1740956
Review Article

Technical Aspects of High-Resolution Color-Coded Duplex Sonography for the Design of Perforator Flaps

Andreas Kehrer 
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Paul I. Heidekrueger
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Daniel Lonic
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Silvan Klein
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Alexandra Anker
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christian D. Taeger
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Niklas Biermann
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Ernst Michael Jung
2   Department of Radiology, Ultrasound Center, University Medical Center Regensburg, Regensburg, Germany
,
Lukas Prantl
1   Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Natascha Platz Batista da Silva
2   Department of Radiology, Ultrasound Center, University Medical Center Regensburg, Regensburg, Germany
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Abstract

Background Technical aspects are of utmost significance for an efficient execution in designing perforator flaps with high-resolution color-coded Duplex sonography (CCDS). The following study evaluates decisive factors for a successful microvessel examination conducted by the microsurgeon.

Methods Technical knowledge presented in this study was based on a series of more than 200 perforator flaps planned with CCDS. Flap reconstructions were performed at the University Hospital Regensburg, Germany, from July 2013 to January 2021. Standard high-resolution ultrasound (US) devices with linear multifrequency transducers of 4 to 18 MHz were used. Modes and device settings were evaluated regarding applicability by microsurgeons. Key steps for safe perforator identification and further optional steps for additional assessment should be discriminated.

Results Different US modes including brightness mode (B-mode), color flow (CF), power Doppler (PD), pulse wave (PW), and blood flow (B-Flow) were used. Transducers from 15 MHz and up were favorable to detect microvessels. Knobology of a standard US device regarding buttons, switches, and specific onscreen options with relevance for perforator mapping was subcategorized in four different groups. For qualitative and quantitative evaluation of microvessels, different US modes were tested with respect to their usefulness.

Vital elements of the CCDS exam are disaggregated into three key steps for safe perforator identification and three optional steps for further perforator characterization. A standardized protocol for the CCDS exams was applied. Downregulation of pulse-repetition frequency/scale to adapt device sensitivity to slow-flow velocities represented the most important criterion to visualize microvessels.

Qualitative microvessel evaluation was performed in B-mode, CCDS, PD mode, and B-Flow mode. Quantitative assessment was executed using PW-mode and CCDS measuring the microvessels' diameter (mm) and flow characteristics. Quantitative information may be obtained using PW-mode and the distance-measuring tool in CF-mode.

Conclusion Technical aspects with respect to proper device trimming and application decisively impact CCDS-guided perforator vessel identification and evaluation.

Keywords

ultrasound - perforator flap - perforator mapping


Publication History

Received: 25 July 2021

Accepted: 09 November 2021

Article published online:
17 January 2022

© 2022. Thieme. All rights reserved.

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