title: The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap.
abstract: The anterolateral thigh (ALT) flap has become a workhorse in reconstructive surgery of the head and neck region and the extremities. However, its inconsistent vascular anatomy and frequent intramuscular course of perforators often cause difficulties during the dissection of this versatile flap. Hence, reliable preoperative perforator mapping and identification of vascular anomalies may render the raising of the flap easier and safer. The aim of this study was to evaluate the use of Color Duplex sonography and whether it allows the distinction between septocutaneous and musculocutaneous perforators. For this purpose, the thighs of 13 patients undergoing reconstruction with ALT flaps were examined preoperatively, and results were compared to intraoperative findings. A total of 30 perforators could be detected preoperatively, of which 29 were confirmed during flap dissection. Preoperative Color Duplex sonography correctly predicted the course of all perforators as either running through the vastus lateralis muscle or the intermuscular septum. In our investigations, Color Doppler sonography had a 96.7% positive predictive value and a 96.7% true positive rate in detecting perforators. Color Duplex sonography is a highly reliable tool in the preoperative assessment of ALT flaps. Localization and course of perforators can be determined accurately and vascular anomalies can be identified.
authors.affiliation: Department of Plastic, Hand-, and Reconstructive Surgery, Barmherzige Brüder Regensburg, Regensburg, Germany. florian.ensat@barmherzige-regensburg.de
authors.forename: Florian
authors.initials: F
authors.lastname: Ensat
authors.forename: Maria
authors.initials: M
authors.lastname: Babl
authors.forename: Christian
authors.initials: C
authors.lastname: Conz
authors.forename: Markus-Johannes
authors.initials: MJ
authors.lastname: Rueth
authors.forename: Markus
authors.initials: M
authors.lastname: Greindl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fichtl
authors.forename: Gerhard
authors.initials: G
authors.lastname: Herzog
authors.forename: Juergen
authors.initials: J
authors.lastname: Ussmueller
authors.forename: Marcus
authors.initials: M
authors.lastname: Spies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012878:Skin Neoplasms / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery; D013848:Thigh / Q000098:blood supply* / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult