Affiliations: Institute of General Surgery, University Hospital Regensburg, Regensburg, Germany | Institute of Trauma, Plastic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany | Institute of Diagnostic Radiology, University Hospital Regensburg, Regensburg, Germany
Note: [] Corresponding author: Philipp Lamby, MD, Department of General Surgery, Regensburg University, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Tel.: +49 941 944 6778; E-mail: philipp.lamby@klinik.uni-regensburg.de.
Abstract: Background: A free-flap graft refers to the free transfer of tissue to cover tissue defects caused by trauma or malperfusion in plastic surgery. The basic principle, which makes a free flap working is an adequate blood flow. We applied new techniques which are able to detect the blood flow of the anastomosis and of dermal and subdermal tissue layers in a reliable way. Methods: To this end we applied innovative Ultrasound-techniques (contrast enhanced high resolution Ultrasound (US), color coded Doppler sonography (CCDS), Cross Beam™, Power Doppler, Tissue Harmonic Imaging™ (THI), Speckle Reduction Imaging™ (SRI)), as well as the Indocyanine Green (ICG) fluorescence angiography to evaluate the vascular integrity of 15 parascapular flaps implanted to the fore foot over a period of four years. The age of the subjects ranged from 16 to 60 years. The US machine (GE Logiq 9) was equipped with a Logiq 9L transducer (6–9 MHz) and the modalities of CHI (Contrast Harmonic Imaging) and True Agent Detection (dual view of B-Mode and contrast mode). Results: The borders of the investigated flaps could be best detected using Cross Beam™ Technology with SRI™ and THI™. Power Doppler was able to detect anastomotic vessels even if they were twisted or elongated. Reduced perfusion curves were seen in cases with low anastomotic flow in CCDS. The CHI™ allowed dynamic flow detection of the microcirculation of the tissue graft over a depth of up to 3 cm including quantitative perfusion curves of tissue microcirculation by using TIC™ analysis. There is a strong correlation between the perfusion indices measured by ICG fluorescence angiography and CHI™. Furthermore the ICG showed a remarkable enhancement of fluorescence in the flap borders, which need to be explored in future investigations. Conclusion: These new applications provide useful and effective methods for improved postoperative monitoring of free flaps in plastic surgery and can lead to substantial reduction in the overall risk of flap failure.
