A Study Of Anterolateral Thigh Flap Cutaneous Perforators With Color Doppler Flow Imaging

Objective To study the distribution,location and hemodynamic parameter of the blood vessel of anterolateral thigh flap(ALTF)with color Doppler flow imaging(CDFI).Methods We examined 120 normal volunteers'cutaneous perforators on both thighs with a broad-spectrum 6-13 MHz linear transducer.The source,number,diameter,course,location,and the hemodynamic parameter were recorded.All these data were analyzed statistically.In the supine position,the patient's thigh length was measured from the anterior superior iliac spine to the centre of the lateral part of the patella.This line corresponds to the lateral intermuscular septum between the vastus lateralis muscle and the rectus femoris muscle.First,the vastus lateralis muscle,rectus femoris muscle and lateral intermuscular septum were identified in B-mode.The femoral artery,profunda femoris artery and lateral circumflex femoral artery(LCFA)were identified in the colour flow mode.The descending branch of the LCFA was also identified between the rectus femoris muscle and the vastus intermedius muscle, and its course and anatomical relation to neighbouring muscles were determined.Then,the cutaneous perforators of the descending branch of the LCFA were located by sliding the introducer very slowly along the line between the anterior superior iliac spine and the centre of the lateral part of the patella,which corresponds to the lateral intermuscular septum. When a cutaneous perforator was found as a blinking narrow line running vertically in the vastus lateralis muscle and entering the subcutaneous fat, the location of the transducer was marked,and the distance from the centre of the lateral part of the patella was measured.The arterial waveform of the cutaneous perforator was also recorded in the pulse wave Doppler mode,and hemodynamic parameter was measured.All these data were analyzed statistically.Results The color Doppler ultrasound with high resolution could show the distribution and location clearly.Cutaneous perforators' PW were characterized of low velocity,high resistance,monophase.The perforators on both left and righ t side were quite not symmetry.The average number of cutaneous perforators was 2.25.They were classified into three types:Ⅰmyocutaneous perforator(65.9%),Ⅱseptocutaneous perforator(30.7%),Ⅲdirect cutaneous perforator(3.4%).178 LCFA derived from DFA.The calibre of dominant cutaneous perforators was 1.49±0.39mm.The distance from anterior superior iliac spine and the centre of lateral part of the patella(0)was divided into nine section.77.4% of cutaneous perforators deriving from LCFA descending branch were located in the sixth,fifth,forth section.66.7%of the dominant were located in the sixth.86.9%of cutaneous perforators penetrating deep fascia were located in the forth,fifth,third.97.1%of the dominant cutaneous perforators were located in the middle third of the thigh.There were no significant differences in the mean velocity between left and right dominant cutaneous perforators and source vessels;The result was alike among age groups;Male's mean velocity was higher than female's(P＜0.05).There were significant differences in the resistence index of descending branch of the LCFA between the old and the young or the middle.Conclusion The color Doppler ultrasound with high resolution could show the distribution and location clearly,access the quality of the blood flow of ALTF,with provided scientific basis for successful grafting,and have better prospects.