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This feasibility study evaluated whether contrast enhanced ultrasound (CEU) was able to assess free flap perfusion following free tissue transfer in the head and neck region. Thirty-six patients underwent standard clinical monitoring (SCM) and CEU postoperatively. The time taken for each technique to detect flap failure was recorded. Qualitative CEU analysis by visual assessment predicted survival in 30/30 (100%) and failure in 5/6 (83%) flaps with sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of 100, 86, 97 and 100%, respectively. Quantitative CEU measurement of blood volume (α) values within healthy perfused flaps was over 60 times higher than in failing flaps (8.25±2.82dB vs. 0.12±0.17dB, respectively, P<0.0001). If a cut-off α value of <1.5dB was used to predict future flap failure, the accuracy of the test was 100% (sensitivity, specificity, PPV, NPV). If a cut-off α value of >1.9dB indicated flap success, the PPV and NPV are 100%. Following surgery, SCM took 76 (±15) h to detect flap failure compared with 18 (±38) h with CEU (P<0.05). CEU is highly accurate in its ability to distinguish between perfused and failing flaps. The technique is quick (<10min) and capable of imaging all flap types.

Original publication

DOI

10.1016/j.ijom.2010.07.013

Type

Journal article

Journal

International journal of oral and maxillofacial surgery

Publication Date

12/2010

Volume

39

Pages

1211 - 1217

Addresses

Department of Oral & Maxillofacial Surgery, Poole Hospitals NHS Foundation Trust, Dorset, UK.

Keywords

Humans, Head and Neck Neoplasms, Ischemia, Postoperative Complications, Contrast Media, Image Enhancement, Ultrasonography, Ultrasonography, Doppler, Blood Volume Determination, Treatment Failure, Reconstructive Surgical Procedures, Logistic Models, Prospective Studies, Feasibility Studies, Predictive Value of Tests, Microbubbles, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Free Tissue Flaps