Examination On Arterial Pedicle Of Axial Pattern Skin Flap By Ultrasonography

Objective: To explore the technique of ultrasonography on detectingarterial pedicle of axial pattern skin flap and to evaluate its clinical value inaid of cutaneous flap designation.Methods: Firstly, the origins, courses, external diameters, length,included angle between internal and external branch of thoracodorsal arterywere observed on 30 cadaver specimens. Secondly, thirty normal personwere included. We examined the origins, length, angle and caliber ofthoracodorsal artery by ultrasonography, these data were compared withcadaver statistically. Also, the number and locations of intermuscularbranches of posterior tibial artery were assessed. Both two arteryhaemodynamics parameters were established in pulse wave Doppler mode,including peak systole velocity, end diastole velocity and resistive index.Finally, with the aid of ultrasonography, preoperative, mapping and sizedetermination of arterial pedicle in 21 various axial pattern skin flaps wereidentified, then these arterial origins, distribution and location were markedon patients'body surface. The skin paddle can then be designed to lieexactly over these arteries, ensuring blood supply to the skin flap.Results: ⑴Of 60 side cadaver specimens, in the lateral thoracicregion, thoracodorsal artery is almost always present. We found the mostcommon origin type of thoracodorsal artery is subcapular artery directlystretch after diverge circumflex scapular artery, its emergence rate was91.67±3.57 percent. The axial angle of TDA was 13.68±1.21°,and theangle between E-TDA and I-TDA was 38.83±2.87°. Ulrasonic imagingrevealed the routine of thoracodorsal artery lie within latissimus dorsimuscle, the axial angle was 19.52±2.93 °in living body. Internaldiameter in TDA , E-TDA and I-TDA were 2.02±0.29 mm, 1.33±0.10mm and 1.07±0.112 mm respectively. Also, the normal parameters ofTDA and its branches haemodynamics were Vmax 42.32±6.65 cm/s,Vmin4.72±1.63 cm/s,RI 0.88±0.027 in TDA;Vmax 31.85±3.51 cm/s,Vmin 4.96±1.14 cm/s,RI 0.83±0.02 in E-TDA and Vmax28.93±3.51cm/s,Vmin4.51±0.75 cm/s,RI 0.812±0.020 in I-TDA. There were nosignificant differences in the morphological data of thoracodorsal arterybetween living body and cadaver specimens(p>0.05), except their axialangle. There were no significant differences in the blood flow parametersbetween left and right thoracodorsal artery. ⑵114 intermuscular branchesof posterior tibial artery were identified in 30 side leg ultrasonically, 85.96±3.25 percent were located in the one third mid-segment of leg, whichdirected through spatium intermuscular. Those cutaneous perforatorsinternal diameter smaller than 0.5mm were not displayed byultrasonography. the normal parameters of intermuscular branches ofposterior tibial artery haemodynamics were Vmax 20.80±5.27 cm/s,Vmin 2.86±0.63 cm/s,RI 0.84~ 0.89。⑶Of 21 clinical skin flaps, all theaxial artery located by ultrasonography were confirmed intraoperatively.Conclusions: It appears from this study that axial pattern skin flapaxial artery can be identified ultrasonically based on their morphologyand anatomical layer. Furthermore, color Doppler ultrasonography shouldbe a useful imaging modality to assess the arterial pedicle of axial skin flap,accordingly, it is available to clinical skin flap designation as well asoperative performance.