OBJECTIVE: To investigate the accuracy of color Doppler ultrasound (CDU) and CT angiography (CTA) in the preoperative evaluation of perforator vessels in free posterior interosseous artery perforator (PIAP) flaps. METHODS: Between January 2020 and December 2023, 19 patients with hand skin and soft tissue defects caused by trauma were admitted. There were 11 males and 8 females, with a median age of 45 years (range, 26-54 years). The interval between injury and admission was 5-11 days (mean, 7.2 days). The skin and soft tissue defects were located on the dorsum of the hand in 8 cases and on the fingers in 11 cases. The size of defect ranged from 4.0 cm×2.5 cm to 7.5 cm×3.5 cm. After locating the perforator vessels through CDU and CTA before operation, the free PIAP flaps were designed to repair hand defects, with the size of 4.5 cm×3.0 cm-7.5 cm×4.0 cm. The defects of donor sites were directly sutured. The number and diameter of perforator vessels in the posterior interosseous artery detected by CDU and CTA were compared. The differences in localization of perforator vessels using CDU and CTA and their clinical effects were also compared to calculate the accuracy and recognition rate. During follow-up, the survival of the skin flap was observed, and the Vancouver scar scale (VSS) score was used to evaluate the healing of the donor site, while the visual analogue scale (VAS) score was used to evaluate the patient's satisfaction with the appearance of the skin flap. RESULTS: The number and the diameter of PIAP vessels was 5.8±1.2 and (0.62±0.08) mm assessed by CDU and 5.2±1.0 and (0.60±0.07) mm by CTA, showing no significant difference between the two methods ( P>0.05). The number, course, and distribution of perforator vessels of the PIAP vessels observed during operation were basically consistent with those detected by preoperative CDU and CTA. Compared with intraoperative observation results, the recognition rates of dominant perforating vessels by CDU and CTA were 95.0% (18/19) and 89.5% (17/19), respectively, and the accuracy rates were 100% (19/19) and 84.2% (16/19), with no significant difference between the two methods ( P>0.05). All flaps survived after operation, and all wounds and incisions at donor sites healed by first intention. All patients were followed up 6-13 months (mean, 8.2 months). At last follow-up, the skin flaps had elasticity and soft texture，with the patient satisfaction VAS score of 9.2±0.8. The donor sites had no obvious scar hyperplasia with the VSS score of 11.7±0.9. CONCLUSION CDU and CTA accurately identify the dominant perforator vessels and provide reliable information for vessel localization, facilitating precise flap harvesting and minimizing donor site injury. However, CDU offers superior visualization of distal end of perforator vessels in the forearm compared to CTA.
Humans ; Female ; Male ; Adult ; Perforator Flap/blood supply* ; Middle Aged ; Ultrasonography, Doppler, Color/methods* ; Computed Tomography Angiography/methods* ; Soft Tissue Injuries/diagnostic imaging* ; Hand Injuries/diagnostic imaging* ; Plastic Surgery Procedures/methods* ; Hand/surgery* ; Preoperative Care ; Arteries/diagnostic imaging*

OBJECTIVE: To compare the effectiveness of poly ether ether ketone (PEEK) localization marker combined with mixed reality technology versus color doppler ultrasound guidance for the vessel localization of anterolateral thigh perforator flap. METHODS: A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group [using PEEK localization marker combined with mixed reality technology based on CT angiography (CTA) data] and color ultrasound group (using color ultrasound guidance), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration between the two groups ( P>0.05). The number of perforator vessels identified in the two groups of regions of interest was recorded, and compared them with the intraoperative actually detected number to calculate the success identifying rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded. RESULTS: In the PEEK group, 32 perforator vessels were identified, 34 were detected by intraoperative exploration, and the success identifying rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were detected by intraoperative exploration, and the success identifying rate was 87.8% (29/33); there was a significant difference in the success identifying rate between the two groups ( P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group ( P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in follow-up time between the two groups ( P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect. CONCLUSION Compared with the traditional color ultrasound guidance, the PEEK localization marker combined with mixed reality technology based on CTA data in vessel localization of anterolateral thigh perforator flap has higher success identifying rate and positioning accuracy, and the flap production time is shorter, which has high clinical application value.
Humans ; Ketones ; Perforator Flap/blood supply* ; Benzophenones ; Polymers ; Male ; Thigh/blood supply* ; Polyethylene Glycols ; Female ; Ultrasonography, Doppler, Color ; Computed Tomography Angiography ; Plastic Surgery Procedures/methods* ; Mouth Neoplasms/surgery* ; Middle Aged

Adult ; Asthenozoospermia/complications* ; Azoospermia/surgery* ; Humans ; Male ; Microsurgery/methods* ; Oligospermia/complications* ; Orchiectomy ; Seminoma/surgery* ; Testicular Neoplasms/surgery* ; Ultrasonography, Doppler, Color/methods* ; Urologic Surgical Procedures, Male/methods* ; Varicocele/surgery*

Objective We investigated the efficacy and safety of 1064 nm Nd: YAG laser, intense pulsed light (IPL), and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography: group A-1 for those who had a lesion depth <1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth ≥1.2mm and < 3 mm, and took long pulse 1064 nm Nd:YAG laser therapy; group A-3 for those who had a lesion depth ≥3mm and <5 mm, and were treated by IPL combined with long pulse 1064 nm Nd:YAG laser treatment; Group A-4 for those who had a lesion depth ≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd:YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically.Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A (mean age 6.8±7.9 months) and 28 in the group B (mean age 6.9±9.9 months). The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm, 4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B (cure rates: 64.5% vs 56.3%, U=3.378, P=0.045; effective rates: 89.5% vs 78.1%, U=4.163, P=0.041). The adverse effect rates of the group A (vesicle 20.0%, pigmentation 46.9%, scarring 17.7%) were lower than those of the group B (vesicle 21.9%, pigmentation 60.4%, scarring 25.0%). Incidences of pigmentation and scarring were statistically significantly different (U=3.884, P=0.034, and U=4.016, P=0.032 respectively) between the two groups.Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd:YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.
Female ; Hemangioma ; diagnostic imaging ; pathology ; therapy ; Humans ; Infant ; Male ; Ultrasonography, Doppler, Color ; methods

Objective: To investigate the clinical effect and feasibility of internal spermatic vein-inferior epigastric vein (ISV-IEV) bypass surgery in the treatment of varicocele complicated by left renal vein nutcracker syndrome (NCS). METHODS: We retrospectively analyzed the clinical data about 30 cases of varicocele with left renal vein NCS treated by ISV-IEV bypass surgery in our hospital from June 2014 to February 2017. We reviewed the follow-up data and results of ultrasonography, routine urianlysis and semen routine examination. RESULTS: All the operations were successfully accomplished and postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. At 6 months after surgery, sperm concentration and the percentage of grade a+b sperm were significantly improved (［34.47 ± 8.60］ ×10⁶/ml and ［63.54% ± 9.58］ %) as compared with the baseline (［19.90 ± 8.97］ ×10⁶/ml and ［37.93 ± 8.73］ %) (P <0.05). Hematuria was cured in 23 and alleviated in 1 of the 24 cases. Proteinuria disappeared in all the 14 cases, with neither scrotal pain symptoms nor obvious complications. CONCLUSIONS ISV-IEV bypass surgery, with its advantages of safety, effectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of varicocele with left renal vein NCS.
Anastomosis, Surgical ; methods ; Feasibility Studies ; Hematuria ; surgery ; Humans ; Male ; Microsurgery ; methods ; Proteinuria ; surgery ; Renal Nutcracker Syndrome ; complications ; Renal Veins ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler, Color ; Varicocele ; complications ; diagnostic imaging ; surgery ; Vascular Surgical Procedures ; methods ; Veins ; surgery

PURPOSE: The purpose of this study was to evaluate the feasibility and usefulness of sagittal color Doppler ultrasonography (CDUS) for the diagnosis of fetal cleft lip (CL) and cleft palate (CP). METHODS: We performed targeted ultrasonography on 25 fetuses with CL and CP, taking coronal and axial images of the upper lip and maxillary alveolar arch in each case. The existence of defects in and malalignment of the alveolus on the axial image, hard palate defects on the midsagittal image, and flow-through defects on CDUS taken during fetal breathing or swallowing were assessed. We compared the ultrasonography findings with postnatal findings in all fetuses. RESULTS: Alveolar defects were detected in 16 out of 17 cases with CP and four out of eight cases with CL. Alveolar malalignment and hard palate defects were detected in 11 out of 17 cases and 14 out of 17 cases with CP, respectively, but not detected in any cases with CL. Communicating flow through the palate defect was detected in 11 out of 17 cases of CL with CP. The accuracy of detection in axial scans of an alveolar defect and malalignment was 80% and 76%, respectively. Accuracy of detection of in mid-sagittal images of hard palate defect and flow was 80% and 86%, respectively. The overall diagnostic accuracy of combined axial and sagittal images with sagittal CDUS was 92%. CONCLUSION: Sagittal CDUS of the fetal hard palate is a feasible method to directly reveal hard palate bony defects and flow through defects, which may have additional value in the differential diagnosis of fetal CL and CP.
Cleft Lip* ; Cleft Palate ; Congenital Abnormalities ; Deglutition ; Diagnosis ; Diagnosis, Differential* ; Fetus ; Lip ; Methods ; Palate* ; Palate, Hard ; Respiration ; Ultrasonography ; Ultrasonography, Doppler, Color* ; Ultrasonography, Prenatal

PURPOSE: To determine effectiveness of Valsalva maneuver and standing position on scrotal color Doppler ultrasound (CDU) for the varicocele diagnosis. MATERIALS AND METHODS: We reviewed the physical examination and CDU finding in 87 patients who visited National Police Hospital from January 2011 to April 2014. Diameters of pampiniform plexus were measured bilaterally during resting and Valsalva maneuver in the supine position and standing position. We calculated the ratio of mean of maximal vein diameter (mMVD) during resting and Valsalva maneuver (resting-Valsalva ratio) and compared in the both position. RESULTS: In the resting and supine position, mMVD of varicocele testis units were 1.8 mm, 2.1 mm, 2.6 mm (grades I, II, III, respectively), and that of normal testis units (NTU) 1.2 mm. During Valsalva maneuver in the supine position, mMVD were 3.0 mm, 3.4 mm, 4.2 mm (grades I, II, III) vs 1.8 mm (NTU) (p=0.007, p<0.001, p<0.001, respectively). Average of resting-Valsalva ratio in the supine position were 0.69, 0.74, 0.74 (grades I, II, III) and 0.67 (NTU). Whereas in the resting and standing position, mMVD were 2.8 mm, 3.3 mm, 3.8 mm (grades I, II, III) and 1.8 mm (NTU) (p=0.002, p<0.001, p<0.001). During Valsalva maneuver in the standing position, mMVD were 5.0 mm, 5.8 mm, 6.6 mm (grades I, II, III) and 2.5 mm (NTU) (p=0.002, p<0.001, p<0.001). And average resting-Valsalva ratio were 0.76, 0.90, 0.71 (grades I, II, III) and 0.26 (NTU), which showed significant differences from all grades (p<0.001, p<0.001, p<0.001). CONCLUSIONS: It is suggested that the standing position and Valsalva maneuver during CDU could improve diagnostic ability for varicocele. Resting-Valsalva ratio in the standing position could be a new diagnostic index for varicocele diagnosis using CDU.
Adult ; Aged ; Humans ; Male ; Middle Aged ; Patient Positioning/*methods ; Physical Examination/methods ; Posture/physiology ; Scrotum/*ultrasonography ; Supine Position/physiology ; Ultrasonography, Doppler, Color/methods ; *Valsalva Maneuver ; Varicocele/*ultrasonography ; Veins/ultrasonography ; Young Adult

OBJECTIVETo investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps.

METHODSFrom Sept. 2011 to Dec. 2012, 11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps, which were pedicled by the peroneal artery(5 cases), or the lateral supramalleolar artery(3 cases), or the ulnar artery (2 cases), or the posterior interrosseous artery (1 case). The wound size ranged from from 3.0 cm x 2. 5 cm to 11. 0 cm x 4. 0 cm, and the falps size ranged from 6 cm x 3 cm to 21 em x 5 cm. One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area. The blood supply of the flaps were recorded after operation 1 - 3 months after operation, the fluency of anastomosed vein was detected by color Doppler ultrasound. Flap swelling evaluations were performed in early 3 months and later 3 - 6 months, and the results were classified into 4 grading degrees. 6 months later, Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period.

RESULTS9 flaps survived completely, two flaps had partial marginal skin necrosis in the distal end, which were both managed with surgical debridement, and both wounds healed in two months. 9 cases were followed up for more than 12 - 19 months. The early rsults of flap swelling evaluations were: I degree 0 case, II degree 8 cases, III degree 3 cases, IV degree 0 case, and the later results were: I degree 7 cases, II degree 4 cases, III degree 0 case, IV degree 0 case. The flaps had ideal appearance, good contour, and high aesthetic satisfactory (100%). The mean flap survival area rate of veins anastomosed was (98. 6 ± 9. 7) %.

CONCLUSIONSPerforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage, avoid transient venous venous congestion, so as to increase the flap survival. It is an effective way for improving the vein drainage.

Anastomosis, Surgical ; methods ; Debridement ; Extremities ; blood supply ; Graft Survival ; Humans ; Leg Ulcer ; pathology ; surgery ; Perforator Flap ; transplantation ; Regional Blood Flow ; Tibial Arteries ; Ulnar Artery ; Ultrasonography, Doppler, Color ; Veins ; surgery

The diameter and collapsibility of the inferior vena cava (IVC) should be interpreted in consideration with other clinical and echocardiographic parameters before drawing definitive diagnostic conclusions. We report a case of a 46-year-old female with isolated IVC dilation and diminished inspiratory collapse without other abnormalities, and provide a brief review of the literature.
Atrial Function, Right ; Atrial Pressure ; Cardiac Catheterization ; Dilatation, Pathologic ; Echocardiography, Doppler, Color ; Female ; Humans ; Middle Aged ; Phlebography/methods ; Respiratory Mechanics ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*pathology/physiopathology/radiography/ultrasonography

OBJECTIVETo evaluate the long-term outcome of the femoral artery following total percutaneous endovascular aortic repair (EVAR) with preclose technique using a vascular closure device (VCD).

METHODSFrom July, 2009 to July, 2012, total percutaneous EVAR was performed in 113 patients (106 males, 7 females; mean age 59.4∓13.5 years) with pre-close technique, including 60 with Stanford type B aortic dissection, 3 with thoracic aortic aneurysm, and 48 with infra-renal abdominal aortic aneurysm, and 2 with thoracic and abdominal aortic aneurysms. The Technical success and complication rates were evaluated, and the outcomes of the femoral artery were followed up with computed tomography or color Doppler ultrasound.

RESULTSThe overall technical success rate was 97.6% (161/165) with conversion to open surgery in 4 cases. The size of the sheaths used were 24Fr (n=37), 22Fr (n=29), 20Fr (n=24), 18Fr (n=25), 16Fr (n=12) and 14 Fr (n=38), and 347 VCDs were used for hemostasis of 165 femoral sites; 147 femoral sites were closed using 2 VCDs. Four access-related adverse events, including femoral arterial-venous fistula, acute femoral thrombosis, bleeding, and lower extremity ischemia, occurred in 4 (2.4%) of the 165 cases. In cases using ≤18Fr sheaths, the success rate of closure using 2 VCDs was 98.7%, as compared to 81.1% in cases using larger (≥20Fr) sheaths (P=0.0003). The success rate of the 82 anterior sites was lower than that of the 82 posterior sites (82.9% vs 95.2%, P=0.013). No lower extremity ischemia was observed, nor was femoral artery stenosis detected during the follow-up for 26∓9 months (12-50 months) in these cases.

CONCLUSIONTotal percutaneous EVAR with preclose technique using VCD provides a safe and effective alternative to open femoral surgery. The sheath size can be a predictor of percutaneous access failure to require conversion to open femoral surgery or using more than 2 devices for suture. Total percutaneous endovascular aortic repair using VCD with preclose technique is safe and effective, which can be adopted as an alternative technique of surgically femoral arterial cut-down operation when the surgeon reduce the learning curve.

Aged ; Aneurysm, Dissecting ; Angiography ; Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Vascular Closure Devices