Hand Doppler flowmetry for surgical planning of pedicled flap in extensive full-thickness scalp reconstruction. (March 2020)

• Record Type: Journal Article
• Authors: Schonauer, Fabrizio; Abbate, Vincenzo; Dell'Aversana Orabona, Giovanni; Salzano, Giovanni; Sbordone, Carolina; Bonavolontà, Paola; Somma, Teresa; D'Andrea, Francesco; Califano, Luigi
• Is Part Of: Surgical oncology. Volume 32(2020)
• Page Start: 49
• Page End: 56
• Publication Date: 2020-03
• Subjects: Scalp reconstruction -- Scalp local flaps -- Extensive scalp defects -- Doppler ultrasound -- Flap planning; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2019.10.016
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2–25 cm 2 ) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm 2 . Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm 2 ) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred. Highlights: Hand doppler flowmetry is a valid method used in scalp reconstructions. The vascular axis is easily identified with doppler flowmetry. Doppler flowmetry is useful to narrow the flaps pedicle allowing extensive reconstructions.