Improvements in high resolution ultrasound for postoperative investigation of capillary microperfusion after free tissue transfer

Issue title: Papers from the Regensburg Conference, Regensburg, Germany, 5–6 September 2008

Article type: Research Article

Authors: Lamby, P.^; | Prantl, L. | Schreml, S. | Pfister, K. | Mueller, M.P. | Clevert, D.-A. | Jung, E.M.

Affiliations: Department of General Surgery, University Medical Center Regensburg, Regensburg, Germany | Plastic and Reconstructive Surgery, Department of Trauma, University Medical Center Regensburg, Regensburg, Germany | Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany | Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany | Interdisciplinary Ultrasound Center, Department of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany | Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany

Note: [] Corresponding author: Philipp Lamby, MD, Department of General Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. E-mail: philipp.lamby@klinik.uni-regensburg.de.

Abstract: Introduction: High resolution ultrasound (US) techniques as implemented in the latest generation of US machines provide imminently better resolution compared to previous high resolution models. This improvement is based on advanced transducer technologies as well as updated post-processing procedures. Furthermore, matrix linear transducers providing frequencies from 6 to 15 MHz are now available. The aim of the study was the evaluation of these new techniques for the immediate postoperative investigation of microcirculation after free tissue transfer by supplemental use of Contrast-Enhanced Ultrasound Imaging (CEUS). Patients and methods: To this end, we investigated 12 patients who underwent free tissue transfer in order to cover tissue defects in various body regions. We utilized the new GE Logiq E9 equipped with a linear 6–9 MHz and a matrix 6–15 MHz probe as well as the GE Logiq 9 with the previous version of the linear 6–9 MHz probe. Both machines provide the modalities of SRI®, Cross Beam® and THI®. The perfusion curves were quantitatively analyzed using digital cine sequences (Qontrast®, Bracco, Italy). Furthermore, two independent investigators evaluated the digitally recorded images with respect to the resolution of details based on a scale ranging from 0 to 5, and after application of 2.4 ml SonoVue® (Bracco, Italy), evaluated the image quality regarding the representation of tissue perfusion. Results: None of the free flaps showed clinical or laboratory signs of flap failure during the hospital stay. Several flaps showed typical perfusion patterns relating to the flap type. The combination of SRI®, Cross Beam® and THI® allows, in most cases, a more exact differentiation of tissue graft outlines and tissue composition, in particular the tissue texture, compared to the use of B-scan only. In addition, the high resolution matrix technology combined with the broader spectrum of 6–15 MHz considerably improves the representation of image details compared to multifrequency probes with 6–9 MHz. The use of updated post-processing procedures as well as new transducer technologies in CEUS also results in improved resolution and thus achieves a higher score compared to previous models. Conclusion: At present, these new US technologies combined with the updated 6–9 MHz probe provide the optimal assessment of perfusion in cutaneous, subcutaneous and deeper tissue layers. The additional use of new multifrequency 6–15 MHz matrix probes improves the resolution in the B-mode to an even higher degree.

Keywords: Contrast-enhanced ultrasound, free flap, microcirculation, matrix technologies

DOI: 10.3233/CH-2009-1219

Journal: Clinical Hemorheology and Microcirculation, vol. 43, no. 1-2, pp. 35-49, 2009