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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(01): e52-e63
DOI: 10.1055/a-2241-2323
Original Article

Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Vanesa Lovětínská
1   Department of Orthopaedics and Department of Radiodiagnostics, Military University Hospital Prague, 1st Faculty of Medicine of Charles University, Praha, Czech Republic
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Andrej Sukop
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Jakub Sulženko
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Adam Hora
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Matěj Patzelt
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Boris Kožnar
2   Department of Plastic and Reconstructive Surgery, Department of Radiodiagnostics, Královské Vinohrady University Hospital in Prague, 3rd Faculty of Medicine of Charles University, Praha, Czech Republic
,
Karol Kovačič
1   Department of Orthopaedics and Department of Radiodiagnostics, Military University Hospital Prague, 1st Faculty of Medicine of Charles University, Praha, Czech Republic
,
Michal Kamenistý
4   Department of Medical Technology, Johnson & Johnson, Walterovo nám, Praha, Czech Republic
,
Jozef Kučerák
3   Department of Radiodiagnostics, General University Hospital in Prague, Praha, Czech Republic
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Abstract

Background Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA) and alterations of flow characteristics.

Methods Ten patients with lower extremity defects requiring DSA had undergone examinations by using standard methods. The localization of 40 stable perforators originating from the anterior tibial artery, posterior tibial artery, fibular artery, and medial sural artery was performed before and after angiography. Where stenoses or occlusions were observed, percutaneous transluminal angioplasty (PTA) was conducted, and velocity changes following reperfusion were measured.

Results Angiographic abnormalities were observed in all of patients, thus necessitating PTA interventions. Prior to PTA, handheld acoustic Dopplers detected 37 out of 40 perforators (90%), whereas color-coded sonography detected 35 out of 40 perforators (87.5%). After PTA, these numbers increased to 38 out of 40 (95%) and 37 out of 40 (92.5%), respectively. The diameter of the perforators ranged between 1.14 and 1.16 mm. The mean flow characteristics included the peak systolic velocities (PSV) of 21.9 and 27.2, end-diastolic velocities (EDV) of 9.4 and 11.4, and resistance indexes (RI) of 0.63 and 0.71, respectively. In the postintervention period, 16 microvessels exhibited enlarged lumen diameters ranging from 1 to 3 mm, resulting in increased perfusion values for PSV in 85.2% (21.9/27.2) and EDV in 88.2% (9.4/11.4) of the patients. The RI increased from 0.63 to 0.71. However, two perforators showed decreases in flow velocity after PTA.

Conclusion In most patients with chronic lower leg wounds and other comorbidities, adequate perforators for reconstruction can be identified by using conventional methods. PTA interventions positively impact blood flow in perforators, although they are not necessarily required prior to reconstruction.

Keywords

acoustic doppler - color-coded duplex - DSA - perforator - PTA - thermal imaging camera


Publication History

Received: 27 August 2023

Accepted: 18 December 2023

Accepted Manuscript online:
09 January 2024

Article published online:
03 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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