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Han T, Khavanin N, Zhu S, Zang M, Chen B, Li S, Wu J, Liu Y. A Comparison of Handheld Doppler and Indocyanine Green Angiography for Perforator Localization. Ann Plast Surg 2022; 89:89-94. [PMID: 35703215 DOI: 10.1097/sap.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The preoperative identification of perforators is critical to the success of perforator flaps. Several technologies, including handheld Doppler (HHD) and indocyanine green angiography (ICGA), facilitate this process; however, each technology comes with unique downsides. This study directly compares the performance of HHD and ICGA in preoperative perforator identification and measures the effects of flap thickness and body mass index (BMI) on perforator localization. METHOD Data from preoperative HHD and ICGA assessments were compared with the criterion standard of intraoperative perforator localization. Sensitivity, specificity, accuracy, and positive predictive values were calculated for both and correlated with flap thickness and BMI. RESULTS Thirty flaps were transferred in 30 patients across 15 different donor sites. Indocyanine green angiography had higher sensitivity, accuracy, and positive predictive value (79.2%, 74.2%, and 87.5%, respectively) than HHD (55.6%, 46.6%, and 69.4%, respectively). Perforators detected by ICGA were used as flap pedicles in 21 cases compared with 13 with HHD. There were no correlations between HHD or ICGA performance and patient BMI (both P > 0.05). Increasing flap thickness was negatively correlated with the accuracy of ICGA ( P = 0.001) but not HHD ( P > 0.05). CONCLUSIONS Indocyanine green angiography was more sensitive, specific, and accurate than HHD in identifying perforators across various donor sites; however, its performance suffered in thicker flaps, whereas HHD did not. Patient BMI was not correlated with the performance of either technology. Additional research can further delineate the interrelationships of flap thickness and technologies for perforator localization.
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Affiliation(s)
- Tinglu Han
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Nima Khavanin
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shan Zhu
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengqing Zang
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Chen
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shanshan Li
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanbo Liu
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Malhotra A, Shah UA, Chakraborty SS, Baraiya D, Shetty SP, Babu SR, Dandekar PB. Reconstruction of Postburn Mild Anterior Neck Contracture With a Free Thin Anterolateral Thigh Flap. PLASTIC AND AESTHETIC NURSING 2022; 42:39-42. [PMID: 36450074 DOI: 10.1097/psn.0000000000000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this article, we describe reconstruction of a McCauley's Grade I postburn anterior neck contracture with extensive scarring in a 34-year-old woman using a free thin anterolateral thigh (ALT) flap. To our knowledge, this is the first case of reconstruction of Grade I neck contracture using a thin ALT flap that has been reported. By selecting the correct patient, adhering to recommended standards of microvascular technique, and implementing appropriate postoperative nursing care, we achieved a near-normal neck contour in this patient in a single-staged procedure.
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Affiliation(s)
- Anjana Malhotra
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Urvi Ashok Shah
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Sourabh Shankar Chakraborty
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Dhaval Baraiya
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Shrikrishna Prasad Shetty
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Shylesh Ramesh Babu
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Puja Bhaurao Dandekar
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
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