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Comparison between Different Perforator Imaging Modalities for the Anterolateral Thigh Perforator Flap Transfer: A
Lucas M Ritschl1, Andreas M Fichter1, Achim von Bomhard1
1Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
Journal of Reconstructive Microsurgery
|July 27, 2020
Summary
Indocyanine green angiography (ICGA) offers superior accuracy for anterolateral thigh perforator flap (ALTPF) imaging compared to hand-held Doppler (hhD) and color duplex ultrasonography (CDU). ICGA demonstrated higher sensitivity and positive predictive value in identifying perforators for flap harvest.
Area of Science:
- Plastic Surgery
- Surgical Imaging
- Microsurgery
Background:
- Perforator imaging is crucial for successful perforator flap harvest.
- Hand-held Doppler (hhD) and color duplex ultrasonography (CDU) are common radiation-free methods.
- The anterolateral thigh perforator flap (ALTPF) is a frequently used flap in reconstructive surgery.
Purpose of the Study:
- To compare the accuracy, reliability, and feasibility of hhD and CDU against indocyanine green angiography (ICGA) for ALTPF.
- To evaluate the effectiveness of different imaging modalities in identifying perforators for flap harvest.
Main Methods:
- Prospective study including consecutive ALTPF procedures.
- Independent and randomized visualization of perforators using hhD, CDU, and ICGA by three investigators.
- Registration of perforator presence, distance, and patient confounders (BMI, ASA status, smoking, alcohol, diabetes, age, gender).
Main Results:
- 30 perforators were detected in 12 patients.
- ICGA visualized perforators significantly more precisely than hhD and CDU (p < 0.001 and p = 0.001).
- ICGA achieved 100% sensitivity and 100% positive predictive value, outperforming hhD (67%, 62%) and CDU (73%, 64%).
Conclusions:
- ICGA is a more accurate imaging method for ALTPF perforators than standard hhD and CDU.
- ICGA offers superior sensitivity and positive predictive value for perforator identification.
- ICGA provides consistent, excellent results, while hhD and CDU show variability in performance.
