Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Guillaume Goudot; Yanis Berkane; Eloi de Clermont-Tonnerre; Claire Guinier; Irina Filz von Reiterdank; Antonia van Kampen; Korkut Uygun; Curtis L. Cetrulo; Basak E. Uygun; Anahita Dua; Alexandre G. Lellouch

doi:10.3389/fphys.2022.1063240

Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Guillaume Goudot
, Yanis Berkane
, Eloi de Clermont-Tonnerre
, Claire Guinier
, Irina Filz von Reiterdank
, Antonia van Kampen
, Korkut Uygun
, Curtis L. Cetrulo
, Basak E. Uygun
, Anahita Dua
, Alexandre G. Lellouch

Advanced Technologies for Preservation of Biological Systems (ATP-BIO)

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery’s collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.

Original language	English (US)
Article number	1063240
Journal	Frontiers in Physiology
Volume	13
DOIs	https://doi.org/10.3389/fphys.2022.1063240
State	Published - Dec 15 2022

Bibliographical note

Funding Information:
GG was funded by the Federation Française de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cassées and Shriners Children Boston (#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant #85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged.

Funding Information:
GG was funded by the Federation Française de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cassées and Shriners Children Boston (#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant #85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged.

Publisher Copyright:
Copyright © 2022 Goudot, Berkane, de Clermont-Tonnerre, Guinier, Filz von Reiterdank, van Kampen, Uygun, Cetrulo, Uygun, Dua and Lellouch.

Keywords

flap surgery
microcirculation
Microvascular flow imaging
microvascularization
MV-Flow
pig
vascularity index

PubMed: MeSH publication types

Journal Article

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10.3389/fphys.2022.1063240

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@article{227436fc262e436f8adb1eb43ad24cc4,

title = "Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study",

abstract = "Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery{\textquoteright}s collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.",

keywords = "flap surgery, microcirculation, Microvascular flow imaging, microvascularization, MV-Flow, pig, vascularity index",

author = "Guillaume Goudot and Yanis Berkane and \{de Clermont-Tonnerre\}, Eloi and Claire Guinier and \{Filz von Reiterdank\}, Irina and \{van Kampen\}, Antonia and Korkut Uygun and Cetrulo, \{Curtis L.\} and Uygun, \{Basak E.\} and Anahita Dua and Lellouch, \{Alexandre G.\}",

note = "Funding Information: GG was funded by the Federation Fran{\c c}aise de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cass{\'e}es and Shriners Children Boston (\#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant \#85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged. Funding Information: GG was funded by the Federation Fran{\c c}aise de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cass{\'e}es and Shriners Children Boston (\#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant \#85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged. Publisher Copyright: Copyright {\textcopyright} 2022 Goudot, Berkane, de Clermont-Tonnerre, Guinier, Filz von Reiterdank, van Kampen, Uygun, Cetrulo, Uygun, Dua and Lellouch.",

year = "2022",

month = dec,

day = "15",

doi = "10.3389/fphys.2022.1063240",

language = "English (US)",

volume = "13",

journal = "Frontiers in Physiology",

issn = "1664-042X",

publisher = "Frontiers Media SA",

}

TY - JOUR

T1 - Microvascular assessment of fascio-cutaneous flaps by ultrasound

T2 - A large animal study

AU - Goudot, Guillaume

AU - Berkane, Yanis

AU - de Clermont-Tonnerre, Eloi

AU - Guinier, Claire

AU - Filz von Reiterdank, Irina

AU - van Kampen, Antonia

AU - Uygun, Korkut

AU - Cetrulo, Curtis L.

AU - Uygun, Basak E.

AU - Dua, Anahita

AU - Lellouch, Alexandre G.

N1 - Funding Information: GG was funded by the Federation Française de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cassées and Shriners Children Boston (#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant #85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged. Funding Information: GG was funded by the Federation Française de Cardiologie and the Institut Servier. YB was funded by CHU de Rennes, Fondation des Gueules Cassées and Shriners Children Boston (#84308-BOS-22). Shriners Hospitals partially funded this work for Children grant #85127-BOS-20 (BU) and 85015-BOS-23 (KU, CC, AL). AK was funded by the American Heart Association Postdoctoral Fellowship Award. The US. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. This work was supported by the Office of Assistant Secretary of Defense for Health Affairs through the Reconstructive Transplant Research Program, Technology Development Award under Awards No. W81XWH-19-1-0440 (CC, KU), W81XWH-17-1-0680 (KU, CC, AL), W81XWH-21-RTRP-IIRA (CC, AL). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This material is partially based upon work supported by the National Science Foundation under Grant No. EEC 1941543. Partial support from the US National Institutes of Health (R01EB028782) is gratefully acknowledged. Publisher Copyright: Copyright © 2022 Goudot, Berkane, de Clermont-Tonnerre, Guinier, Filz von Reiterdank, van Kampen, Uygun, Cetrulo, Uygun, Dua and Lellouch.

PY - 2022/12/15

Y1 - 2022/12/15

N2 - Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery’s collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.

AB - Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery’s collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.

KW - flap surgery

KW - microcirculation

KW - Microvascular flow imaging

KW - microvascularization

KW - MV-Flow

KW - pig

KW - vascularity index

UR - https://www.scopus.com/pages/publications/85145256195

UR - https://www.scopus.com/pages/publications/85145256195#tab=citedBy

U2 - 10.3389/fphys.2022.1063240

DO - 10.3389/fphys.2022.1063240

M3 - Article

C2 - 36589429

AN - SCOPUS:85145256195

SN - 1664-042X

VL - 13

JO - Frontiers in Physiology

JF - Frontiers in Physiology

M1 - 1063240

ER -

Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Abstract

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ATP-Bio: NSF Engineering Research Center for Advanced Technologies for the Preservation of Biological Systems (ATP-Bio)

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Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

Abstract

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ATP-Bio: NSF Engineering Research Center for Advanced Technologies for the Preservation of Biological Systems (ATP-Bio)

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