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OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
Subject(s)
Male , Female , Humans , Thigh/surgery , Plastic Surgery Procedures , Prospective Studies , Skin Transplantation , Free Tissue Flaps , Burns , Soft Tissue Injuries/surgery , Ultrasonography, Doppler, Color , Crush Injuries/surgery , Perforator Flap , Treatment OutcomeABSTRACT
Objective: To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Methods: Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. Results: The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly. Conclusion: Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.
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Objective: To investigate the application value of high frequency color Doppler flow imaging(CDFI)combined with serum fibrinogen(FIB)and sugar antigen 19-9(CA199)in the preoperative diagnosis of breast cancer.Methods: The clinical data of 226 patients with space occupying lesion of breast were analyzed retrospectively.According to the confirmed situation of postoperative pathological examination,they were divided into breast cancer group(158 cases)and breast disease group(68 cases).All patients received examination of preoperative CDFI and detections of preoperative serum FIB and CA199,and the values of single CDFI examination and it combined with detection of serum FIB and CA199 in preoperative diagnosis of breast cancer were compared.Results: In breast cancer group(158 patients),the ultrasonographic images of 146 patients showed the lumps were hypoechoic or weak echoes,irregular shape and uneven surface,and showed the change of lump appeared cauliflower shape,lobulated or crab foot shape.And the levels of serum FIB and CA199 of breast cancer group were significantly higher than those of breast disease group(t=6.821,t=20.061,P＜0.05),respectively.The sensitivity,negative predictive value and diagnostic coincidence rate of CDFI examination combined with detections of FIB and CA199 for diagnosis of breast cancer were 89.24％,79.76％and 92.04％,respectively.And these were significantly higher than those of single CDFI examination(x2=100.148,x2=37.666,x2=79.636,P＜0.05),respectively.Conclusion: The value of high frequency CDFI examination combined with serum FIB and CA199 in the preoperative diagnosis of breast cancer is significantly higher than that of single examination and single detection,and it has clinical application value.
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Objective To investigate the relationship between ultrasonographic features of papillary thy-roid carcinoma(PTC)and lateral cervical lymph node metastasis (LCLNM).Methods A total of 449 eligible ca-ses with 633 PTC nodules was selected and divided into two groups:LCLNM group included 135 nodules(91 pa-tients);Without metastatic groups included 498 nodules(135 patients).Ultrasonographic features of PTC nodules and the relationship with LCLNM were analyzed by χ2 test and logistic regression analysis .Results In univariate analysis,the significant factors were male,age1 cm),multi-microcal-cificaltion(d<2 mm),mixed flow,wider than tall,CCLNM,extrathyroid extension,located in upper(P<0.05 or P<0.017).Multivariate analysis showed that multi -microcalcificaltion(d<2 mm),wider than tall,CCLNM,ex-trathyroid extension,located in upper pole were predictive factors of LCLNM (P<0.005,OR=1.626,2.644, 0.479,2.579).Conclusion High-frequency ultrasound can accurately describe the sonographic appearance of thyroid nodules;it can be used to remind the risk of LCLNM before operation ,and will be informative for the treat-ment of surgery .
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Purpose:To study the value of high frequency color doppler ultrasound diagnosis for breast intraductal papilloma.Methods:50 patients with breast intraductal papilloma,all confirmed by surgical and pathology,and examined by ultrasound before surgery,all had symptoms of excreting blood or liquid from nipple or palpable mass. The probe were placed on the surface of the breast to scan radially from nipple,after finding the enlarged duct,try to detect the neoplasm in it carefully. The two dimensional images were observed and the color Doppler flow codes were detected.Results:The detection rate and the diagnostic accuracy rate of breast intraductal papilloma by ultrasound are 62.0% and 38.0% respectively,ultrasonography is better than mammography and near infrared light scanning.The images were divided into four types:one type of no unusual finding(7 cases),one type of finding both the enlarged duct and the tumor(19 cases),one type of finding the enlarged duct only(12 cases),one type of finding the tumor only(12 cases),the images of the type of finding both the enlarged duct and the tumor are typical. The detection rate of flow by color doppler ultrasound is low(5/50).Conclusions:The high frequency color doppler ultrasound is valuable in diagnosis of breast intraductal papilloma,and the special symptom ,the accurate detection method and the typical images are the key of ultrasound diagnosis.
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Objective:To investigate the sensitivities and specificities of high-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy in diagnosis of secondary hyperparathyroidism(SHPT)in uremia patients.Methods: High-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy were performed in 35 uric patients to detect the hyperplastic parathyroid glands. Then biopsies with thin needles were conducted with B ultrasound instruction in hyperplastic glands to determine the sensitivities and specificities of the above techniques and free combination of each 2 of them in diagnosis of SHPT. Results: The sensitivities /specificities of high-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy were 73%/95%, 75%/93% and 89%/98%, respectively; the sensitivity/specificity of 4 combinations: high-frequency color doppler ultrasonography plus CT, high-frequency color doppler ultrasonography plus 99m Tc-MIBI biphasic scintigraphy, CT plus 99m Tc-MIBI biphasic scintigraphy,and high-frequency color doppler ultrasonography plus CT plus 99m Tc-MIBI biphasic scintigraphy were 84%/90%, 93%/93%, 95%/93%, and 100%/90%, respectively. Conclusion: The sensitivity of 99m Tc-MIBI biphasic scintigraphy SHPT is higher than that of high-frequency color doppler ultrasonography and CT, but the specificity is not significantly different 3 photographic techniques. However, combination of high-frequency color doppler ultrasonography and 99m Tc-MIBI biphasic scintigraphy is simple and sensitive and can be regarded as the first choice for diagnosis of SHPT in uremia patients.