Thin and superthin perforator flap elevation based on preoperative planning with ultrahigh-frequency ultrasound

The ability to directly harvest thin and superthin perforator flaps without jeopardizing their vascularity depends on knowledge of the microsurgical vascular anatomy of each perforator within the subcutaneous tissue up to the dermis. In this paper, we report our experience with ultrahigh-frequency ultrasound (UHF-US) in the preoperative planning of thin and superthin flaps. Between May 2017 and September 2018, perforators of seven patients were preoperatively evaluated by both ultrasound (using an 18-MHz linear probe) and UHF-US (using 48- and 70-MHz linear probes). Thin flaps (two cases) and superthin flaps (five cases) were elevated for the reconstruction of head and neck oncologic defects and lower limb traumatic defects. The mean flap size was 6.5×15 cm (range, 5×8 to 7.5×23 cm). No complications occurred, and all flaps survived completely. In all cases, we found 100% agreement between the preoperative UHF-US results and the intraoperative findings. The final reconstructive outcomes were considered satisfactory by both the surgeon and the patients. In conclusion, UHF-US was found to be very useful in the preoperative planning of thin and superthin free flaps, as it allows precise anticipation of very superficial microvascular anatomy. UHF-US may represent the next frontier in thin, superthin, and pure skin perforator flap design.

Keywords

Superthin flap - Supermicrosurgery - Perforator flaps - Resurfacing - Lower extremity

This article was presented at the 30th Meeting of European Association of Plastic Surgeons (EURAPS; May 23-25, 2019, in Helsinki, Finland), the 68th Annual Meeting of Italian Society of Plastic Surgery (SICPRE; September 26-28, 2019, in Palermo, Italy), and the 28th Meeting of the Italian Society of Microsurgery (SIM; November 21-23, 2019, in Genoa, Italy).

Special thanks to the invaluable artwork made by Antonia Conti (Medical Illustrator, Riccione, Italy).

Publication History

Received: 24 August 2019

Accepted: 17 April 2020

Article published online:
25 March 2022

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