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  • Title: [Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects].
    Author: Wang D, Liu L, Zhang K, Xu T, Liao S, Wang X, Han R, Liu Y, Guo Z.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Nov 15; 34(11):1417-1422. PubMed ID: 33191700.
    Abstract:
    OBJECTIVE: To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. METHODS: Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. RESULTS: Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. CONCLUSION: The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy. 目的: 探讨超声造影（contrast-enhanced ultrasound，CEUS）技术辅助腹壁浅动脉穿支皮瓣修复口腔颌面部缺损的应用价值。. 方法: 选取 2018 年 6 月—2020 年 2 月拟行腹壁浅动脉穿支皮瓣修复的口腔癌患者 16 例，男 10 例，女 6 例；年龄 24～77 岁，平均 55.8 岁。其中鳞状细胞癌 13 例，腺样囊性癌 2 例，黏液表皮样癌 1 例。术前均利用常规彩色多普勒超声（color Doppler ultrasound，CDUS）和 CEUS 对腹壁浅动脉进行筛选、辅助腹壁浅动脉穿支皮瓣的设计，并与术中实际探查情况进行比较，分析 CEUS、CDUS 检查的灵敏度、特异度、阳性预测值和阴性预测值。16 例患者中采用腹壁浅动脉穿支皮瓣修复 14 例，2 例由于未找到源动脉转为旋髂浅动脉皮瓣修复。术后定期随访，检查肿瘤复发、转移情况，评价患者供受区外观、经口进食功能恢复情况及有无并发症等情况。. 结果: 术前 CDUS 和 CEUS 检查结果与术中探查结果比较显示，CEUS 在腹壁浅动脉穿支皮瓣血管探查上，灵敏度、特异度、阳性预测值和阴性预测值均为 100%，而 CDUS 分别为 57%、100%、100%、25%。采用腹壁浅动脉皮瓣修复的 14 例术前 CDUS 发现 25 条粗细不一的穿支血管，经 CEUS 增强后所有血管信号均增强，并额外发现 11 条穿支血管并在术中均被证实。术前 CEUS 测量的腹壁浅动脉起始管径均明显高于 CDUS 和术中测量值（ P<0.05）；CEUS 和 CDUS 测量的收缩期峰值速度比较差异有统计学意义（ t=3.708， P=0.003）。1 例腹壁浅动脉穿支皮瓣于术后 48 h 发生静脉栓塞危象，探查抢救无好转，受区创面延期愈合。其余供、受区切口均Ⅰ期愈合。术后患者均获随访，随访时间 3～12 个月，平均 8 个月。随访过程中无肿瘤复发、转移出现，未出现腹壁疝等严重并发症，腹部瘢痕位置隐蔽，患者均恢复经口进食。. 结论: 腹壁浅动脉穿支皮瓣供区损伤小、瘢痕位置隐蔽，是修复口腔颌面部缺损的较好选择。采用 CEUS 技术辅助腹壁浅动脉穿支皮瓣术前设计具有良好可行性和较高准确度。.
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