Application Of High Frequency Color Doppler Ultrasound In Preoperative Design And Evaluation Of Perforator Flap

Objective: By using high-frequency color Doppler ultrasound technique,to locate and examine perforator vessels before operation and provide accurate basis for preoperative design and operation of flap transplantation.Methods: Between October 2015 and January 2018,18 patients with perforator flap were examined by high frequency color Doppler ultrasonography before operation: perforator point of perforator flap,rough direction,diameter of tube,peak systolic velocity(PSV)and Resistance index(RI).According to the detection results,locate the fulcrum position on the body surface,and the perforator vessel with wide diameter,fast SVP and straight direction is preferred.The flap is designed and cut,and the results are compared with those observed during the operation.Results: A total of 31 perforating branches were detected in the donor area of the flap in 18 patients,with an average of 1.72 perforator branches found in each donor area.All 30 perforator vessels were confirmed during operation.Compared with the data of the same group of flaps,the superior perforated blood vessels wereselected to design the flaps,and the mean diameter,peak systolic velocity and resistance index of each group were calculated,including4 in superficial epigastric arteries,6 in superior wrist branches of ulnar artery,2 in superficial palmar branches of radial artery,10 in perforator branches of peroneal artery,6 in perforator branches of descending branch of lateral femoral circumflex artery and 2 in perforating branches of radial collateral artery(1 of which had anatomic variation).All the 16 skin flaps survived,and the wounds healed in one case.Only 1 case was found to be missing in the perforating branch of the cubital fossa,another pedicled flap was used to repair the wounds of the back of the hand,and 1 case survived with partial necrosis of the distal flaps after operation.All the patients were followed up after dressing change.The follow-up time was 4 ~ 14 months(8 months as average).The skin flap was S a t i s f a c t o r y i n a p p e a r a n c e a n d g o o d i n t e x t u r e.Conclusion: High frequency color Doppler ultrasound can directly observe the perforator point,diameter,shape and hemodynamics of perforating vessels,according to the statistics of average pipe diameter,peak velocity and resistance index,this paper provides a basis for selecting the flap and how to design the skin flap before operation,guiding the operation and improving the survival rate of the flap.