Application Of High Frequency Color Doppler Flow Imaging Combined With Wide-field Imaging In Anterolateral Thigh Perforator Flaps

Objective: To investigate the application of using combo of high frequency color Doppler flow imaging(HFCDFI)and wide-field imaging in preoperative navigation of femoral artery flap graft.Methods: From August 2016 to February 2019,a total of 74 patients with skin and soft tissue defects and scar contracture were collected.There were 52 males and 22 females with an average age of 35.5-years.The etiologies are as follows: 22 cases of traffic accident injury,14 cases of heavy object injury,12 cases of falling injury,12 cases of machine strangulation,8 cases of scalded scar and 6 cases of infected ulcer.The body distributions are as follows: 26 legs,23 foot,20 hands and wrist,5 heads and necks.The wound area range from 6.0cm × 3.5cm to 36.0cm × 11.0cm,accompanied by different degrees of tendon and nerve.All the wounds were repaired with free lateral circumflex thigh artery perforating branch flap.There were 24 cases in HFCDFI group from August2016 to November 2016,29 cases in the group of HFCDFI combined with wide-view imaging from January 2017 to October 2018),21 cases in the group of HFCDFI combined wide-view imaging DSA(Digital Subtraction Angiography)from January 2017 to February 2019.Spiral stock detected by longitudinal and horizontal comparative analysis The blood supply source,diameter,quantity,course,body surface position,blood flow imaging and relationship with the body area of the lateral artery penetrating branch were determined according to the information of the piercing branch of the source artery,and the superior perforating branch was determined to be the vascular pedicle to design the flap,and the skin and soft tissue defect of the patient was repaired and reconstructed by the flap.The ranges of flaps are from 7.0cm × 4.5cm to 38.0cm × 12.0cm.Direct closure or conversion of ilioinguinal flap to cover the donor flap.Results: HFCDFI group: a total of 51 piercing branches were detected by HFCDFI among 24 patients.During the operation,4 perforating branches were found in rectusfemoris without myocutaneous branches.All the superior penetrating branches were detected,and they were further confirmed during the operation.The matching percentage was 92.2%.Among them,only 1 case(4.17%)had dominant perforating branch from oblique branch and the left 23 cases(95.83%)had dominant perforating branch from the descending branch of lateral circumflex thigh artery.After operation,necrosis was found in the edge of the flap in 1 case,which was considered as vascular crisis.It healed gradually after dressing change.A total of 5 cases were treated with adjacent relay flaps in the donor valve area,primaryly.A total of 17 cases were followed up for 3 to 24 months,with an average of 12 months.The flaps had good blood supply,good elasticity and satisfactory appearances and functions.No dysfunction was found in the area of donor flaps.HFCDFI combined with wide-view imaging group: a total of 69 branches of penetrating branches were detected by HFCDFI combined with wide-view imaging before operation.A total of 24 cases(82.76%)from descending branches and 5 cases(17.24%)from oblique branches were detected successfully.The presences of dominant piercing branches were confirmed during operation.The matching percentage between the characteristics and the results of preoperative wide-view map was 100%.Compared with HFCDFI alone,HFCDFI combined with wide-view imaging could show the relationship between the perforating branch of descending branch or oblique branch and its course between rectus femoris and lateral thigh muscle in the same image.It could also show the blood vessels,vessels diameter,penetration points,piercing muscle sites,as well as subcutaneous fat and muscle thickness.The safety and efficiency of operations were improved by more intuitionistic and comprehensive understanding of the relationship between perforating branches and branches.The flaps survived completely in 28 patients after operation and healed after dressing change in 1 patient.The donor areas were sutured directly and the wounds healed.All patients were followed up for 3 to 12 months,with an average of 9 months.The flaps had good blood supply,good elasticity,good shapes and functions in both donor areas and recipient areas.HFCDFI combined with wide-field imaging DSA group: 21 patients were detected by HFCDFI combined with wide-field imaging before operation.At the same time,DSA examination was performed,and the detection results matched with HFCDFI combined with wide scene imaging.It was furhter confirmed during the operation.The locations ofperforators were accurate,and the matching percentage between the walking characteristics and the exploration results was 100%.A total of 52 branches were detected,16 cases(76.19%)were from dominant descending branches,5 cases(23.81%)were from oblique branches.A total of 6 cases were covered with adjacent relay flaps,and the rest were sutured directly.All of them healed primaryly.5 cases were followed up after operation.All patients were followed up for 3 to 12 months,with an average of 8 months.The flap has good blood supply,good elasticity,good shapes and functions in both donor areas and recipient areas.Conclusion: High frequency color Doppler flow imaging combined with wide scene imaging navigation could show the characteristics of perforating branches,hemodynamic informations before operation,which could improve the success and operation efficiencyies of flap resections.This method is non-invasive,repeatable,radiation-free,economical and practical,which is worthy of clinical application.