Application Of Contrast-enhanced Ultrasound In The Reconstruction Of Oral And Maxillofacial Tissue Defect With Perforator Flap

Objective: To investigate the application value of perforator flaps assisted by contrast-enhanced ultrasound(CEUS)in the repair of oral and maxillofacial tissue defects.Methods: From January 2020 to January 2022,15 patients with oral tumor requiring flap repair were selected,including 11 cases repaired with ALTPF and 4cases repaired with DCIAPF.The perforator vessels were detected by conventional color Doppler ultrasound(CDUS)and CEUS before operation.The number,diameter and peak systolic velocity(PSV)of the perforators were compared.The course of the perforators and their relationship with the main trunk were tracked,and the superficial exit points of the perforators were marked.Among the perforators detected by CEUS,the vessels with thick diameter,fast flow rate,and short intermuscular course were selected as the dominant perforators.During the operation,the surface marker of the dominant perforator was taken as the center,and the perforator flap was designed and prepared according to the size and shape of the tissue defect in the recipient area.The coincidence rate of the surface marker of the dominant perforator before operation was compared.The patients were followed up for 6-12 months to evaluate the maxillofacial shape,function and donor site complications.Results: 1.Compared with CDUS,CEUS detected 8 more perforating vessels.The average diameter and flow velocity of the inferior perforator detected by CEUS were larger than those detected by CDUS,and the difference was statistically significant(P < 0.05).2.CDUS showed that 21% of the perforators only showed point or strip signals.After contrast enhancement of microbubbles,the blood flow signal of perforators was enhanced,and the course,relationship with the main trunk and superficial exit points on the body surface were clearly displayed.3.There was no significant difference in the coincidence rate of CDUS and CEUS in the location of the surface exit point of the dominant perforator(P > 0.05).4.The flaps were designed and prepared based on the dominant perforators of CEUS.All 15 flaps survived successfully.All patients were satisfied with the appearance and function of maxillofacial region.No obvious complications occurred in the donor site.Conclusion: Compared with CDUS,CEUS can improve the preoperative screening and localization of perforator vessels,and has high clinical application value in the repair of oral and maxillofacial tissue defects with perforator flaps.