title: Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical value of color coded Doppler sonography (CCDS) and contrast-enhanced harmonic imaging (CHI) for ultrasound (US) monitoring the integrity of free-flap vascular grafts. Patency of microvascular anastomoses and perfusion as well as microcirculation of the transplanted tissue were analysed.
  
  
  METHODS
  Fifteen free parascapular flap grafts performed over a period of three years by a single surgeon were examined with CCDS and CHI. The patients (12 male, 3 female) ranged in age from 16 to 60 years (average age 40+/-12). The follow-up period ranged from two weeks to 2.5 years. CCDS were performed with a multifrequency linear transducer (5-10 MHz, Logiq 9, GE) with 3D flow detection. For detection and characterization, B scan of the flap tissue was compared to tissue harmonic imaging (THI) and Cross Beam with Speckle Reduction Imaging (SRI). US Pulse Inversion Harmonic Imaging (PIHI) after bolus injection of 2.5 ml Sonovue was used for contrast enhancement.
  
  
  RESULTS
  Border and tissue structure of the flaps could be detected best in all 15/15 cases using Cross Beam Technology with SRI and THI. Correlations were found for flow parameters of the common femoral artery, popliteal artery and lower leg artery to the anastomotic vessels. 3D imaging with CCDS facilitated flow detection of elongated and small anastomotic vessels in 4/15 cases. Contrast-enhanced US with PIHI allowed dynamic flow detection of the microcirculation of the transplanted tissue over a depth of up to 3 cm with quantitative perfusion curves of the tissue microcirculation. Reduced US contrast enhancement with modified perfusion curves was seen in 2/15 cases with low anastomic flow in CCDS.
  
  
  CONCLUSIONS
  Assessment of microvascular perfusion with contrast-enhanced ultrasound can provide valuable information on free flap viability. Contrast-enhanced US enables dynamic and quantitative flow detection of free flap tissue.
authors.affiliation: Institute of Plastic and Reconstructive Surgery, University Hospital Regensburg, Germany. lukas.prantl@klinik.uni-regensburg.de
authors.forename: L
authors.initials: L
authors.lastname: Prantl
authors.forename: K
authors.initials: K
authors.lastname: Pfister
authors.forename: R
authors.initials: R
authors.lastname: Kubale
authors.forename: St
authors.initials: S
authors.lastname: Schmitt
authors.forename: V
authors.initials: V
authors.lastname: Stockhammer
authors.forename: W
authors.initials: W
authors.lastname: Jung
authors.forename: N
authors.initials: N
authors.lastname: Zorger
authors.forename: T
authors.initials: T
authors.lastname: Herold
authors.forename: M
authors.initials: M
authors.lastname: Nerlich
authors.forename: A
authors.initials: A
authors.lastname: Stehr
authors.forename: E M
authors.initials: EM
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity; D001808:Blood Vessels / Q000502:physiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D012680:Sensitivity and Specificity; D012867:Skin / Q000098:blood supply*; D013524:Surgical Flaps; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media