Arch Hand Microsurg.  2021 Dec;26(4):270-275. 10.12790/ahm.21.0105.

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

• Lee KJ
• Park I
• Roh SY
• Koh SH
• Kim JS
• Lee DC
• Koo JH

• KMID: 2522625
• DOI: http://doi.org/10.12790/ahm.21.0105

Abstract

Purpose
The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.
Methods
A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.
Results
A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).
Conclusion
Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

Keyword

Color Doppler ultrasonography; Perforator flaps; Operative time

Figure

• 

  Fig. 1. Color Doppler ultrasound preoperative assessment (perforator 33). (A) The location and course of the perforator surges through the superficial fascia (left arrow) from the vastus lateralis aponeurosis (deep fascia, right arrow). (B) The flow of the perforator is measured using the color Doppler flowmeter.

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  Fig. 2. Intraoperative photographs of harvesting a thin anterolateral thigh (ALT) flap (perforator 33). (A) The ALT flap is harvesting on the plane of the superficial fascia, being careful for the predicted perforator (arrow). (B) The perforator (arrow) is saved, and recorded in the orthonormal coordinate system. The patient provided written informed consent for the publication and the use of his images.

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  Fig. 3. Overall distribution of perforators during surgery. A total of 37 perforators during surgery were plotted in the orthonormal coordinate system. Area B has the most perforators (22), followed by areas A and C. Blue, musculocutaneous type; pink, septocutaneous type.

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