Preoperative mapping of perforator flaps using ultrasound triplex angioscanning for head and neck defects reconstruction

The objective of the study was to develop an algorithm for searching perforator vessels and preoperative planning of the design of the anterolateral thigh perforator flap (ALT) and superficial circumflex iliac artery perforator flap (SCIP) using ultrasound triplex angioscanning (UTAS) and compare the data obtained with intraoperative localization of perforator vessels. Methods and materials. From January 2023 to May 2024, 8 patients with defects and neoplasms of the maxillofacial area, who underwent preoperative preparation with bilateral UTAS of soft tissues of the anterolateral thigh and groin area, were monitored at the University Clinic. At the level of the interested anatomical structures, the maximum systolic blood flow velocity (maxSBFV), resistance index (RI), perforator vessel localization and the depth of it were assessed. All patients underwent surgery soon, during which a comparison was made between angioscanning data and the intraoperative view. The UTAS protocol for two flaps with parameter settings of the ultrasound diagnostic device was described in detail. Results. Thus, eight patients underwent head and neck reconstruction. The average age of the patients was 41.25 years (25–63 years), the average body mass index (BMI) was 27.2 (26.14±2.47 kg/m2), 5 ALTPF and 3 SCIAPF were transplanted. The average maxSBFV values at the level of the superficial circumflex iliac artery in SCIAPF were 28.56±18.46 cm/s, in ALTPF at the level of the descending branch of the lateral circumflex femoral artery were 49.86±15.02 cm/s. The results of measuring maxSBFV and RI in perforator vessels at the level of deep and superficial fascia were also described. Conclusion. Triplex angioscanning of blood vessels provides both anatomical and hemodynamic information for donor and recipient sites. The surgeon’s training in UTAS techniques allows the operator to carefully assess the donor area before surgery, which will reduce unpredictable situations intraoperatively.