title: Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning.
abstract: BACKGROUND
  Along with technical advancements in perforator flap surgery, great interest has been recently focused on the accuracy of preoperative perforator location through the assessment of the donor-site vascular network. The goal of the present study was to investigate the usefulness of contrast-enhanced ultrasound combined with three-dimensional reconstruction in the planning of perforator flaps.
  
  
  METHODS
  The authors retrospectively analyzed the preoperative imaging vascular anatomy provided by contrast-enhanced ultrasound combined with three-dimensional reconstruction in 32 patients undergoing perforator flap reconstruction between 2009 and 2011. The static and dynamic features of any suitable perforator including number of branches, source vessel, running course, blood flow pattern and velocity (peak systolic velocity and resistance index), and its anatomical relationship were assessed preoperatively by the novel navigation imaging. Based on this information, the preferred perforator and the ideal donor site were selected for the flap harvesting. The accuracy of preoperative imaging data was checked during surgery.
  
  
  RESULTS
  Contrast-enhanced ultrasound provided a continuous blood flow signal and a clear and reliable image of perforators, and three-dimensional reconstruction displayed their spatial anatomical relationship and their roots. Consistent with the surgical findings, perforators were identified accurately in all 32 cases with high specificity (100 percent) and sensitivity.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound with three-dimensional image reconstruction provides valuable preoperative perforator navigation. It detects precisely the perforator's location, its course, and the quality of its blood flow and allows the choice of the preferred perforator and the ideal donor site. Preoperative location of perforators using contrast-enhanced ultrasound with three-dimensional image reconstruction improves flap planning and eases flap harvesting.
  
  
  METHODS
  Diagnostic, IV.
authors.affiliation: Shanghai, People's Republic of China; Florence and Pisa, Italy; and Philadelphia, Pa. From the Departments of Plastic and Reconstructive Surgery and Ultrasound Diagnosis, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; the Reconstructive Microsurgery and Maxillofacial Surgery Units, Hospital of Florence; the Plastic and Reconstructive Surgery Unit, Hospital of Pisa; and the Department of Orthopedic Surgery, Hospital of University of Pennsylvania.
authors.forename: Weijie
authors.initials: W
authors.lastname: Su
authors.forename: Linguo
authors.initials: L
authors.lastname: Lu
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Danru
authors.initials: D
authors.lastname: Wang
authors.forename: Marco
authors.initials: M
authors.lastname: Innocenti
authors.forename: Yunliang
authors.initials: Y
authors.lastname: Qian
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.forename: Caroline
authors.initials: C
authors.lastname: Messmer
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D010743:Phospholipids; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride