PMID- 22960301
OWN - NLM
STAT- MEDLINE
DCOM- 20130805
LR  - 20221207
IS  - 1875-8622 (Electronic)
IS  - 1386-0291 (Linking)
VI  - 52
IP  - 2-4
DP  - 2012
TI  - Postoperative evaluation of microvascularization in mandibular reconstructions 
      with microvascular flaps - first results with a new perfusion software for 
      contrast-enhanced sonography (CEUS).
PG  - 187-96
LID - 10.3233/CH-2012-1596 [doi]
AB  - PURPOSE: Quantitative measurement of dynamic contrast values obtained by 
      contrast-enhanced ultrasound (CEUS) for evaluating microvascularization in 
      osseous and osseocutaneous free flaps used for maxillofacial reconstructions. 
      PATIENTS AND METHODS: 22 patients (6 women, 16 men, mean age: 57 years, range: 47 
      to 82 years) who had received mandibular reconstructions with 3 avascular and 19 
      microvascular free osseous or osseocutaneous transplants were included in this 
      trial. 16 patients had received a microvascular osseocutaneous fibular flap, 2 
      patients a microvascular osseous fibular flap and 1 patient a microvascular 
      osseous iliac crest flap. Patients were followed up for 12 months on average 
      (range: 3 to 20 months). Ultrasound examination was carried out by one 
      experienced examiner with a linear probe (6-9 MHz, LOGIQ E9, GE) after the 
      intravenous bolus injection of 2.4 ml contrast agent (SonoVue(R), BRACCO, Germany). 
      Digital cine loops were analysed with a quantification software (VueBox) for 
      determining wash-in parameters: Rise Time (RT), Peak Enhancement (PE), Wash-in 
      Area Under the Curve (WiAUC) and Wash-in Rate (WiR). Results were compared with 
      the patients' postoperative clinical outcome. RESULTS: For the bone area the 
      median of the RT was 10.0 s (range 3.1 to 65.0 s), for the ratio between bone 
      tissue and soft tissue for the PE the median was 10.4% (range 2.6 to 29.8%), the 
      median for the WiAUC was 11.1% (range 1.5 to 77.7%) and the median for the WiR 
      was 5.7 %(range 0.7 to 61.1%). None of the patients with microvascular 
      osseocutaneous and osseous flaps showed any signs of transplant bone loss, which 
      corresponded with the qualitative CEUS assessment. The patients with 
      microvascular re-anastomosed transplants showed widely varying values for the 
      investigated parameters (RT, PE, WiAUC, WiR). For patients with avascular bone 
      transplants, these parameters were reduced to zero values for the bone area 
      resulting in a significant difference (p < 0.05) for the PE compared to the 
      patients with microvascular bone transplants. CONCLUSION: CEUS allowed the 
      qualitative assessment of bone microvascularization by observing the transition 
      of the contrast agent from the periostal area into the bone. However, defining a 
      critical lower border by quantification of bone perfusion was difficult because 
      of the inconstant perfusion of the bone transplants used in the trial.
FAU - Mueller, S
AU  - Mueller S
AD  - Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, 
      Regensburg, Germany. steffen.mueller@klinik.uni-regensburg.de
FAU - Gosau, M
AU  - Gosau M
FAU - Wendl, C M
AU  - Wendl CM
FAU - Prantl, L
AU  - Prantl L
FAU - Wiggermann, P
AU  - Wiggermann P
FAU - Reichert, T E
AU  - Reichert TE
FAU - Jung, E M
AU  - Jung EM
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - Netherlands
TA  - Clin Hemorheol Microcirc
JT  - Clinical hemorheology and microcirculation
JID - 9709206
RN  - 0 (Contrast Media)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Contrast Media
MH  - Female
MH  - Free Tissue Flaps/blood supply/surgery
MH  - Humans
MH  - Male
MH  - Mandible/*diagnostic imaging/surgery
MH  - Mandibular Osteotomy/methods
MH  - Mandibular Reconstruction/*methods
MH  - Microcirculation
MH  - Middle Aged
MH  - Perfusion/methods
MH  - Plastic Surgery Procedures/*methods
MH  - Skin/blood supply/*diagnostic imaging
MH  - Software
MH  - Surgical Flaps/*blood supply/surgery
MH  - Ultrasonography
EDAT- 2012/09/11 06:00
MHDA- 2013/08/06 06:00
CRDT- 2012/09/11 06:00
PHST- 2012/09/11 06:00 [entrez]
PHST- 2012/09/11 06:00 [pubmed]
PHST- 2013/08/06 06:00 [medline]
AID - E2185581R67K1631 [pii]
AID - 10.3233/CH-2012-1596 [doi]
PST - ppublish
SO  - Clin Hemorheol Microcirc. 2012;52(2-4):187-96. doi: 10.3233/CH-2012-1596.