title: Preoperative Imaging for Thoracic Branch of Supraclavicular Artery Flap: A Comparative Study of Contrast-Enhanced Ultrasound With Three-Dimensional Reconstruction and Color Duplex Ultrasound.
abstract: OBJECTIVE
  The thoracic branch of supraclavicular artery (TBSA) flap has been widely used to reconstruct face and neck defects. However, the branches of the supraclavicular artery (SCA) exhibit considerable anatomical variations. The aim of this study was to evaluate and compare the role of contrast-enhanced ultrasound (CEUS) with 3-dimensional (3D) reconstruction and regular color duplex ultrasonography (CDUS) in the preoperative assessment of TBSA flap.
  
  
  METHODS
  From May 2009 to October 2013, 20 patients (involving 26 flaps) receiving anterior chest flaps for lower face and neck reconstruction underwent both CDUS and CEUS with 3D reconstruction preoperatively for detecting the TBSAs. The number of TBSAs, their caliber, peak systolic velocity (PSV), and course were recorded. In case of an absent TBSA, the second and third perforators of the internal mammary artery were detected. The preoperative imaging data were compared with the intraoperative findings to evaluate the value of CDUS and CEUS with 3D reconstruction for planning and performing the TBSA flaps. All patients were followed up for more than 1 year.
  
  
  RESULTS
  A total of 37 TBSAs in 16 flaps were found by CDUS with a mean caliber of 0.6 ± 0.1 mm and a mean PSV of 13.1 ± 1.6 cm/s, whereas 48 TBSAs in 20 flaps were found by CEUS with a mean caliber of 0.8 ± 0.2 mm and a mean PSV of 12.5 ± 2.1 cm/sec. In 18 flaps with TBSA PSV above 10 cm/s, pedicled TBSA flaps were performed, whereas pedicled or free internal mammary artery flaps were chosen as alternative for the remaining 8 flaps. All 48 TBSAs were found intraoperatively and their origin from the SCA confirmed, indicating specificity and positive predictive value of both CDUS and CEUS were 100% in localizing TBSA preoperatively, whereas sensitivity and negative predictive value of CEUS were higher than using CDUS.
  
  
  CONCLUSIONS
  The branches of SCA have marked anatomical variations. CEUS with 3D reconstruction has advantages over CDUS for the preoperative assessment of the donor-site vascular supply of TBSA flaps.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China; and †Hand, Plastic, Aesthetic Surgery, Department of General, Trauma, Hand, Plastic Surgery, University of Munich, Munich, Germany.
authors.forename: Yashan
authors.initials: Y
authors.lastname: Gao
authors.forename: Yuwen
authors.initials: Y
authors.lastname: Yuan
authors.forename: Haizhou
authors.initials: H
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: Gu
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Tanja
authors.initials: T
authors.lastname: Herrler
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Li
authors.forename: Tao
authors.initials: T
authors.lastname: Zan
mesh_terms: D000328:Adult; D002056:Burns / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D003287:Contrast Media