A single-center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times
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A single-center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times. / Thomas, Benjamin; Haug, Valentin; Falkner, Florian; Arras, Christian; Nagel, Sarah S.; Boecker, Arne; Schmidt, Volker J.; Kneser, Ulrich; Bigdeli, Amir K.
I: Microsurgery, Bind 42, Nr. 1, 2022, s. 40-49.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - A single-center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times
AU - Thomas, Benjamin
AU - Haug, Valentin
AU - Falkner, Florian
AU - Arras, Christian
AU - Nagel, Sarah S.
AU - Boecker, Arne
AU - Schmidt, Volker J.
AU - Kneser, Ulrich
AU - Bigdeli, Amir K.
PY - 2022
Y1 - 2022
N2 - Introduction We reported on the superiority of preoperative Duplex mapping ("Duplex") over audible Dopplers ("Doppler") in anterolateral thigh perforator (ALT) free flaps for upper extremity reconstruction. To corroborate our findings on a larger cohort, we conducted this present study focusing on surgical efficiency and patient safety. Methods 150 consecutive ALT free flaps were divided into 65 cases of preoperative Duplex versus 85 Doppler controls. We first compared patient demographics, operative details, and defect and flap characteristics. We then assessed group differences in the number and course of perforators pursued intraoperatively, flap harvest and operative times, and donor-site complications. Additionally, the impact of the training level of the primary microsurgeon was evaluated. Results Cases and controls were comparable regarding age (p = .48), sex (p = .81), ASA class (p = .48), and BMI (p = .90). Duplex was associated with an increased likelihood of raising flaps on one single dominant perforator of purely septal course and significant reductions of flap harvest (68 +/- 10 min, p < .0001) and operative times (74 +/- 16 min, p < .0001), regardless of the experience of the primary microsurgeon. There were strong negative linear correlations between preoperative Duplex and both the flap harvest and operative times (p < .0001). Additionally, while there was no effect on the emergency take-back rate (OR = 1.3, p = .60), revisions were significantly less likely among duplexed patients (OR = 0.15, p = .04). Conclusions Preoperative Duplex is associated with a significant reduction in ALT free flap harvest and overall operative times, as well as donor-site revisions as opposed to Doppler planning, regardless of the training level of the primary microsurgeon.
AB - Introduction We reported on the superiority of preoperative Duplex mapping ("Duplex") over audible Dopplers ("Doppler") in anterolateral thigh perforator (ALT) free flaps for upper extremity reconstruction. To corroborate our findings on a larger cohort, we conducted this present study focusing on surgical efficiency and patient safety. Methods 150 consecutive ALT free flaps were divided into 65 cases of preoperative Duplex versus 85 Doppler controls. We first compared patient demographics, operative details, and defect and flap characteristics. We then assessed group differences in the number and course of perforators pursued intraoperatively, flap harvest and operative times, and donor-site complications. Additionally, the impact of the training level of the primary microsurgeon was evaluated. Results Cases and controls were comparable regarding age (p = .48), sex (p = .81), ASA class (p = .48), and BMI (p = .90). Duplex was associated with an increased likelihood of raising flaps on one single dominant perforator of purely septal course and significant reductions of flap harvest (68 +/- 10 min, p < .0001) and operative times (74 +/- 16 min, p < .0001), regardless of the experience of the primary microsurgeon. There were strong negative linear correlations between preoperative Duplex and both the flap harvest and operative times (p < .0001). Additionally, while there was no effect on the emergency take-back rate (OR = 1.3, p = .60), revisions were significantly less likely among duplexed patients (OR = 0.15, p = .04). Conclusions Preoperative Duplex is associated with a significant reduction in ALT free flap harvest and overall operative times, as well as donor-site revisions as opposed to Doppler planning, regardless of the training level of the primary microsurgeon.
KW - DONOR-SITE MORBIDITY
KW - COMPUTED TOMOGRAPHIC ANGIOGRAPHY
KW - HAND-HELD DOPPLER
KW - PREOPERATIVE EVALUATION
KW - RECONSTRUCTIVE SURGERY
KW - ULTRASOUND
KW - SONOGRAPHY
KW - NERVES
KW - HEAD
U2 - 10.1002/micr.30775
DO - 10.1002/micr.30775
M3 - Journal article
C2 - 34165203
VL - 42
SP - 40
EP - 49
JO - International Journal of Microsurgery
JF - International Journal of Microsurgery
SN - 0738-1085
IS - 1
ER -
ID: 314448548