Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software
Abstract 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 distu...
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| Veröffentlicht in: | Handchirurgie, Mikrochirurgie, plastische Chirurgie Mikrochirurgie, plastische Chirurgie, 2015-12, Vol.47 (6), p.389-395 |
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| container_title | Handchirurgie, Mikrochirurgie, plastische Chirurgie |
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| creator | Geis, S. Klein, S. Prantl, L. Dolderer, J. Lamby, P. Jung, E.-M. |
| description | Abstract
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. |
| doi_str_mv | 10.1055/s-0035-1559712 |
| format | Article |
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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.</description><identifier>ISSN: 0722-1819</identifier><identifier>EISSN: 1439-3980</identifier><identifier>DOI: 10.1055/s-0035-1559712</identifier><identifier>PMID: 26515800</identifier><language>eng</language><publisher>Stuttgart · New York: Georg Thieme Verlag KG</publisher><subject>Female ; Free Tissue Flaps - blood supply ; Free Tissue Flaps - pathology ; Free Tissue Flaps - surgery ; Humans ; Image Interpretation, Computer-Assisted - methods ; Male ; Microcirculation - physiology ; Middle Aged ; Necrosis ; Original Article ; Phospholipids ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - pathology ; Software ; Sulfur Hexafluoride ; Tissue Survival - physiology ; Ultrasonography, Doppler, Color - methods</subject><ispartof>Handchirurgie, Mikrochirurgie, plastische Chirurgie, 2015-12, Vol.47 (6), p.389-395</ispartof><rights>Georg Thieme Verlag KG Stuttgart · New York.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c294t-de2c5b5be94fed9105b3736a2a6ea1b05359b10c7d21fe74fa150516465159813</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0035-1559712.pdf$$EPDF$$P50$$Gthieme$$H</linktopdf><linktohtml>$$Uhttps://www.thieme-connect.de/products/ejournals/html/10.1055/s-0035-1559712$$EHTML$$P50$$Gthieme$$H</linktohtml><link.rule.ids>314,780,784,3018,27924,27925,54559,54560</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26515800$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Geis, S.</creatorcontrib><creatorcontrib>Klein, S.</creatorcontrib><creatorcontrib>Prantl, L.</creatorcontrib><creatorcontrib>Dolderer, J.</creatorcontrib><creatorcontrib>Lamby, P.</creatorcontrib><creatorcontrib>Jung, E.-M.</creatorcontrib><title>Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software</title><title>Handchirurgie, Mikrochirurgie, plastische Chirurgie</title><addtitle>Handchir Mikrochir plast Chir</addtitle><description>Abstract
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.</description><subject>Female</subject><subject>Free Tissue Flaps - blood supply</subject><subject>Free Tissue Flaps - pathology</subject><subject>Free Tissue Flaps - surgery</subject><subject>Humans</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Male</subject><subject>Microcirculation - physiology</subject><subject>Middle Aged</subject><subject>Necrosis</subject><subject>Original Article</subject><subject>Phospholipids</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - pathology</subject><subject>Software</subject><subject>Sulfur Hexafluoride</subject><subject>Tissue Survival - physiology</subject><subject>Ultrasonography, Doppler, Color - methods</subject><issn>0722-1819</issn><issn>1439-3980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kEtPAjEYRRujEUS3Lk2Xbqp9TGfaJSGgJCZqELdNh_kGSuaBbUfCv3cIuLqbk5t7D0L3jD4xKuVzIJQKSZiUOmP8Ag1ZIjQRWtFLNKQZ54QppgfoJoQt7dEk5ddowFPJpKJ0iMxnZ5vooo3uF_A4BAihhibitsQzD4Bnld3hb2dzV7l4wHsXN3gyXS7wMrhmjW2D502EtbcRCvwBvuyCaxu8aMu4tx5u0VVpqwB35xyh5Wz6NXklb-8v88n4jay4TiIpgK9kLnPQSQmF7q_lIhOp5TYFy3IqhdQ5o6us4KyELCktk1SyNDke0YqJEXo89e58-9NBiKZ2YQVVZRtou2BYlmmVKSVVjz6c0S6voTA772rrD-ZfSg-QExA3Dmow27bzTT_eMGqO0k0wR-nmLF38AZxmcQU</recordid><startdate>20151201</startdate><enddate>20151201</enddate><creator>Geis, S.</creator><creator>Klein, S.</creator><creator>Prantl, L.</creator><creator>Dolderer, J.</creator><creator>Lamby, P.</creator><creator>Jung, E.-M.</creator><general>Georg Thieme Verlag KG</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20151201</creationdate><title>Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software</title><author>Geis, S. ; Klein, S. ; Prantl, L. ; Dolderer, J. ; Lamby, P. ; Jung, E.-M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c294t-de2c5b5be94fed9105b3736a2a6ea1b05359b10c7d21fe74fa150516465159813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Female</topic><topic>Free Tissue Flaps - blood supply</topic><topic>Free Tissue Flaps - pathology</topic><topic>Free Tissue Flaps - surgery</topic><topic>Humans</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Male</topic><topic>Microcirculation - physiology</topic><topic>Middle Aged</topic><topic>Necrosis</topic><topic>Original Article</topic><topic>Phospholipids</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - pathology</topic><topic>Software</topic><topic>Sulfur Hexafluoride</topic><topic>Tissue Survival - physiology</topic><topic>Ultrasonography, Doppler, Color - methods</topic><toplevel>online_resources</toplevel><creatorcontrib>Geis, S.</creatorcontrib><creatorcontrib>Klein, S.</creatorcontrib><creatorcontrib>Prantl, L.</creatorcontrib><creatorcontrib>Dolderer, J.</creatorcontrib><creatorcontrib>Lamby, P.</creatorcontrib><creatorcontrib>Jung, E.-M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Handchirurgie, Mikrochirurgie, plastische Chirurgie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Geis, S.</au><au>Klein, S.</au><au>Prantl, L.</au><au>Dolderer, J.</au><au>Lamby, P.</au><au>Jung, E.-M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software</atitle><jtitle>Handchirurgie, Mikrochirurgie, plastische Chirurgie</jtitle><addtitle>Handchir Mikrochir plast Chir</addtitle><date>2015-12-01</date><risdate>2015</risdate><volume>47</volume><issue>6</issue><spage>389</spage><epage>395</epage><pages>389-395</pages><issn>0722-1819</issn><eissn>1439-3980</eissn><abstract>Abstract
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.</abstract><cop>Stuttgart · New York</cop><pub>Georg Thieme Verlag KG</pub><pmid>26515800</pmid><doi>10.1055/s-0035-1559712</doi><tpages>7</tpages></addata></record> |
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| ispartof | Handchirurgie, Mikrochirurgie, plastische Chirurgie, 2015-12, Vol.47 (6), p.389-395 |
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| source | MEDLINE; Thieme Connect Journals |
| subjects | Female Free Tissue Flaps - blood supply Free Tissue Flaps - pathology Free Tissue Flaps - surgery Humans Image Interpretation, Computer-Assisted - methods Male Microcirculation - physiology Middle Aged Necrosis Original Article Phospholipids Postoperative Complications - diagnostic imaging Postoperative Complications - pathology Software Sulfur Hexafluoride Tissue Survival - physiology Ultrasonography, Doppler, Color - methods |
| title | Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software |
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