Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model

Jonathan P. Christiansen; Howard Leong-Poi; Lester R. Amiss; David B. Drake; Sanjiv Kaul; Jonathan R. Lindner

doi:10.1016/S0301-5629(01)00523-3

Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model

Jonathan P. Christiansen
, Howard Leong-Poi
, Lester R. Amiss
, David B. Drake
, Sanjiv Kaul
, Jonathan R. Lindner

Producción científica: Article › revisión exhaustiva

20 Citas (Scopus)

Resumen

The purpose of this study was to assess perfusion in a free skin flap model using contrast-enhanced ultrasound (CEU), and to determine if the extent of perfusion early after venous occlusion predicted long-term flap survival. Perfusion was assessed in an autologous abdominal skin flap and adjacent healthy skin in rats using CEU imaging before venous occlusion and following reflow. Perfusion assessment was possible in all flaps and quantitative measurements of microvascular blood volume (BV) and blood velocity were expressed as a ratio to that in the healthy skin. Proximal flap BV 18 h after venous occlusion was significantly greater in those that survived (n = 4) vs. those that became necrotic (n = 6) (BV ratio 0.8 ± 0.1 vs. 0.2 ± 0.1, p = 0.0001). A BV ratio of 0.5 predicted graft viability with a sensitivity and specificity of 100%. Microvascular blood velocity at 18 h was similar in grafts that survived and those that became necrotic. Qualitative assessment of perfusion by a 'blinded' observer correlated well with quantitative data and predicted flap outcome in all cases. We conclude that skin perfusion can be assessed with CEU. Perfusion 18 h following a secondary ischemic insult in a free flap accurately predicts subsequent tissue survival in this model.

Idioma original	English
Páginas (desde-hasta)	315-320
Número de páginas	6
Publicación	Ultrasound in Medicine and Biology
Volumen	28
N.º	3
DOI	https://doi.org/10.1016/S0301-5629(01)00523-3
Estado	Published - 2002

Nota bibliográfica

Funding Information:
This study was supported by grants HL-03810, HL-48890, HL-65704 from the National Institutes of Health, Bethesda, MD. Jonathan Christiansen is the recipient of a Postdoctoral Fellowship Award from the American Heart Association, Mid-Atlantic Affiliate, Baltimore, MD. Howard Leong-Poi is the recipient of a Fellowship Training Grant from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada, Ottawa, ONT, Canada.

Financiación

This study was supported by grants HL-03810, HL-48890, HL-65704 from the National Institutes of Health, Bethesda, MD. Jonathan Christiansen is the recipient of a Postdoctoral Fellowship Award from the American Heart Association, Mid-Atlantic Affiliate, Baltimore, MD. Howard Leong-Poi is the recipient of a Fellowship Training Grant from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada, Ottawa, ONT, Canada.

Financiadores	Número del financiador
Mid-Atlantic Affiliate, Baltimore
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)	R01HL065704
American Heart Association
Canadian Institutes of Health Research
Heart and Stroke Foundation of Canada

ASJC Scopus subject areas

Biophysics
Radiological and Ultrasound Technology
Acoustics and Ultrasonics

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10.1016/S0301-5629(01)00523-3

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title = "Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model",

abstract = "The purpose of this study was to assess perfusion in a free skin flap model using contrast-enhanced ultrasound (CEU), and to determine if the extent of perfusion early after venous occlusion predicted long-term flap survival. Perfusion was assessed in an autologous abdominal skin flap and adjacent healthy skin in rats using CEU imaging before venous occlusion and following reflow. Perfusion assessment was possible in all flaps and quantitative measurements of microvascular blood volume (BV) and blood velocity were expressed as a ratio to that in the healthy skin. Proximal flap BV 18 h after venous occlusion was significantly greater in those that survived (n = 4) vs. those that became necrotic (n = 6) (BV ratio 0.8 ± 0.1 vs. 0.2 ± 0.1, p = 0.0001). A BV ratio of 0.5 predicted graft viability with a sensitivity and specificity of 100\%. Microvascular blood velocity at 18 h was similar in grafts that survived and those that became necrotic. Qualitative assessment of perfusion by a 'blinded' observer correlated well with quantitative data and predicted flap outcome in all cases. We conclude that skin perfusion can be assessed with CEU. Perfusion 18 h following a secondary ischemic insult in a free flap accurately predicts subsequent tissue survival in this model.",

keywords = "Contrast, Flap, Perfusion, Skin, Ultrasound",

author = "Christiansen, \{Jonathan P.\} and Howard Leong-Poi and Amiss, \{Lester R.\} and Drake, \{David B.\} and Sanjiv Kaul and Lindner, \{Jonathan R.\}",

note = "Funding Information: This study was supported by grants HL-03810, HL-48890, HL-65704 from the National Institutes of Health, Bethesda, MD. Jonathan Christiansen is the recipient of a Postdoctoral Fellowship Award from the American Heart Association, Mid-Atlantic Affiliate, Baltimore, MD. Howard Leong-Poi is the recipient of a Fellowship Training Grant from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada, Ottawa, ONT, Canada.",

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AU - Leong-Poi, Howard

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AU - Drake, David B.

AU - Kaul, Sanjiv

AU - Lindner, Jonathan R.

N1 - Funding Information: This study was supported by grants HL-03810, HL-48890, HL-65704 from the National Institutes of Health, Bethesda, MD. Jonathan Christiansen is the recipient of a Postdoctoral Fellowship Award from the American Heart Association, Mid-Atlantic Affiliate, Baltimore, MD. Howard Leong-Poi is the recipient of a Fellowship Training Grant from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada, Ottawa, ONT, Canada.

PY - 2002

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N2 - The purpose of this study was to assess perfusion in a free skin flap model using contrast-enhanced ultrasound (CEU), and to determine if the extent of perfusion early after venous occlusion predicted long-term flap survival. Perfusion was assessed in an autologous abdominal skin flap and adjacent healthy skin in rats using CEU imaging before venous occlusion and following reflow. Perfusion assessment was possible in all flaps and quantitative measurements of microvascular blood volume (BV) and blood velocity were expressed as a ratio to that in the healthy skin. Proximal flap BV 18 h after venous occlusion was significantly greater in those that survived (n = 4) vs. those that became necrotic (n = 6) (BV ratio 0.8 ± 0.1 vs. 0.2 ± 0.1, p = 0.0001). A BV ratio of 0.5 predicted graft viability with a sensitivity and specificity of 100%. Microvascular blood velocity at 18 h was similar in grafts that survived and those that became necrotic. Qualitative assessment of perfusion by a 'blinded' observer correlated well with quantitative data and predicted flap outcome in all cases. We conclude that skin perfusion can be assessed with CEU. Perfusion 18 h following a secondary ischemic insult in a free flap accurately predicts subsequent tissue survival in this model.

AB - The purpose of this study was to assess perfusion in a free skin flap model using contrast-enhanced ultrasound (CEU), and to determine if the extent of perfusion early after venous occlusion predicted long-term flap survival. Perfusion was assessed in an autologous abdominal skin flap and adjacent healthy skin in rats using CEU imaging before venous occlusion and following reflow. Perfusion assessment was possible in all flaps and quantitative measurements of microvascular blood volume (BV) and blood velocity were expressed as a ratio to that in the healthy skin. Proximal flap BV 18 h after venous occlusion was significantly greater in those that survived (n = 4) vs. those that became necrotic (n = 6) (BV ratio 0.8 ± 0.1 vs. 0.2 ± 0.1, p = 0.0001). A BV ratio of 0.5 predicted graft viability with a sensitivity and specificity of 100%. Microvascular blood velocity at 18 h was similar in grafts that survived and those that became necrotic. Qualitative assessment of perfusion by a 'blinded' observer correlated well with quantitative data and predicted flap outcome in all cases. We conclude that skin perfusion can be assessed with CEU. Perfusion 18 h following a secondary ischemic insult in a free flap accurately predicts subsequent tissue survival in this model.

KW - Contrast

KW - Flap

KW - Perfusion

KW - Skin

KW - Ultrasound

UR - https://www.scopus.com/pages/publications/0036222857

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JO - Ultrasound in Medicine and Biology

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Skin perfusion assessed by contrast ultrasound predicts tissue survival in a free flap model

Resumen

Nota bibliográfica

Financiación

ASJC Scopus subject areas

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