Handchir Mikrochir Plast Chir 2015; 47(06): 389-395
DOI: 10.1055/s-0035-1559712
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software

Kontrastmittelultraschall zur postoperativen Lappenperfusionskontrolle mithilfe einer integrierten Perfusionssoftware
S. Geis
1   Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
,
S. Klein
1   Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
,
L. Prantl
1   Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
,
J. Dolderer
1   Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
,
P. Lamby
1   Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
,
E.-M. Jung
2   Interdisciplinary ultrasound department, University hospital, Regensburg, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 21. Dezember 2014

accepted 28. Juli 2015

Publikationsdatum:
29. Oktober 2015 (online)

Abstract

Purpose: New treatment strategies in oncology and trauma surgery lead to an increasing demand for soft tissue reconstruction with free tissue transfer. In previous studies, CEUS was proven to detect early flap failure. The aim of this study was to detect and quantify vascular disturbances after free flap transplantation using a fast integrated perfusion software tool.

Material and Methods: From 2011 to 2013, 33 patients were examined by one experienced radiologist using CEUS after a bolus injection of 1–2.4 ml of SonoVue®. Flap perfusion was analysed qualitatively regarding contrast defects or delayed wash-in. Additionally, an integrated semi-quantitative analysis using time-intensity curve analysis (TIC) was performed. TIC analysis of the transplant was conducted on a centimetre-by-centimetre basis up to a penetration depth of 4 cm. The 2 perfusion parameters “Time to PEAK” and “Area under the Curve” were compared in patients without complications vs. patients with minor complications or complete flap loss to figure out significant differences. TtoPk is given in seconds (s) and Area is given in relative units (rU)

Results: A regular postoperative process was observed in 26 (79%) patients. In contrast, 5 (15%) patients with partial superficial flap necrosis, 1 patient (3%) with complete flap loss and 1 patient (3%) with haematoma were observed. TtoPk revealed no significant differences, whereas Area revealed significantly lower perfusion values in the corresponding areas in patients with complications. The critical threshold for sufficient flap perfusion was set below 150 rU.

Conclusion: In conclusion, CEUS is a mobile and cost-effective opportunity to quantify tissue perfusion and can even be used almost without any restrictions in multi-morbid patients with renal and hepatic failure.

Zusammenfassung

Ziel: Der Bedarf an Weichteilrekonstruktion mit freiem Gewebetransfer ist durch die neuen Behandlungsmöglichkeiten in der Tumorchirurgie und der Trauma Versorgung stark angestiegen. In vorangegangen Experimenten konnte bereits die Sensitivität von CEUS zur postoperativen Lappenperfusionskontrolle bestätigt werden. Ziel dieser Studie war es mithilfe einer integrierten Perfusionssoftware Veränderungen der Durchblutung freier Lappenplastiken zu detektieren und zu quantifizieren.

Material und Methodik: Von 2011 bis 2013 wurden 33 Patienten nach einer Bolus Injektion von 1–2,4 ml SonoVue® durch einen erfahrenen Radiologen untersucht. Die Lappen-Perfusion wurde qualitativ hinsichtlich eines verzögerten Kontrastmittel Wash-in oder einer Kontrastmittel-Aussparungen und zusätzlich semi-quantitativ mittels einer Geräte integrierten Zeit-Intensität Kurvenanalyse (TIC) analysiert. Die TIC Analyse des Transplantats wurde in 1 cm Schichten bis zu einer maximalen Eindringtiefe von 4 cm durchgeführt. Komplikationslose Verläufe wurden mit Patienten, die keinen regulären postoperativen Verlauf aufwiesen anhand der Perfusionswerte Time to PEAK und Area under the curve verglichen. TtoPk wird in Sekunden (s) und Area in relativen Einheiten (rU) angegeben.

Ergebnisse: Komplikationslose Verläufe wurden in 26 Fällen (79%) beobachtet. In 5 Patienten (15%) zeigte sich eine partielle Lappennekrose, 1 Patient (3%) wies eine komplette Lappennekrose und 1 Patient (3%) ein Lappenhämatom auf. Während der Perusions-Parameter TtoPk keine unterschiedlichen Perfusionswerte beider Gruppen aufwies, zeigten sich beim Perfusionsparameter Area signifikant niedrigere Perfusions-Parameter in der Komplikationsgruppe. Der Grenzwert einer suffizienten Lappendurchblutung konnte auf Werte unter 150 rU festgelegt werden.

Zusammenfassung: CEUS ist eine mobile, kostengünstige Alternative zur Quantifizierung der Gewebedurchblutung und kann beinahe uneingeschränkt bei multi-morbiden Patienten mit eingeschränkter Leber- und Nierenfunktion eingesetzt werden.

 
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