Simplified profunda artery perforator (PAP) flap design using power Doppler ultrasonography (PDU): A prospective study.

Microsurgery 2018 Jul 4;38(5):512-523. Epub 2017 Nov 4.

Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Introduction: Optimal design of PAP flaps requires precise perforator mapping. In a systematic review, Doppler ultrasonography demonstrated the highest sensitivity and positive predictive value (PPV). We present a prospective study of PAP flap design comparing PDU, handheld Doppler (HHD), and clinical findings.

Methods: From May to July 2016, 12 head and neck cancer patients receiving PAP flaps were examined with PDU and HHD. We used PDU to evaluate number, course, emergence point, peak systolic velocity (PSV), and arterial diameter of perforators. PDU skin markings were measured in relation to the groin and gracilis. Distances to the adjacent HHD marking were determined. Diagnostic results were compared with intraoperative findings.

Results: All perforators identified with PDU were confirmed intraoperatively. No sizable perforators found surgically were missed by PDU. Detecting perforators with diameters of ≧0.5 mm, false-negative rate of PDU was zero percent, sensitivity was 100%. Musculocutaneous courses were identified in all perforators and sensitivity of PDU was 96.7%. Arterial diameter was overestimated by PDU (1.49 ± 0.39 vs. 0.75 ± 0.31 mm, P > .05). PSV at the emergence point was 24.5 ± 11.9 cm/s. Average distance from the emergence point to the PDU marking was 2.45 ± 1.90 mm (0-6 mm). The PPV of PDU was calculated at 93.10%. Mean distance from the HHD to the PDU markings was 20.76 ± 16.5 mm (1-70 mm). Assuming PDU findings demonstrated the true anatomy, sensitivity of HHD was calculated with 89.7%, and PPV was 66.7%. All PAP flaps were successful, only minor revisions were needed.

Conclusions: PDU facilitated PAP flap design in all cases and offers a precise, non-invasive diagnostic tool for flap planning.

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http://dx.doi.org/10.1002/micr.30266DOI Listing
July 2018
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(Supplied by CrossRef)
The posterior thigh perforator flap or profunda femoris artery perforator flap
Ahmadzadeh et al.
Plastic and Reconstructive Surgery 2007
Breast reconstruction with the profunda artery perforator flap
Allen et al.
Plastic and Reconstructive Surgery 2012
The adductor flap: A new method for transferring posterior and medial thigh skin
Angrigiani et al.
Plastic and Reconstructive Surgery 2001

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