grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-3-68-77grekov-2516Research ArticleОПЫТ РАБОТЫEXPERIENCE OF WORKПредоперационная разметка перфорантных лоскутов с помощью ультразвукового триплексного ангиосканирования при устранении дефектов головы и шеиPreoperative mapping of perforator flaps using ultrasound triplex angioscanning for head and neck defects reconstructionhttps://orcid.org/0000-0003-4621-5739ШпицерИ. М.ShpitserI. M.

Шпицер Иван Михайлович, врач – челюстно-лицевой хирург, Университетская клиника Научно-образовательного института; аспирант  

127006, Москва, ул. Долгоруковская, д. 4

119034, Москва, ул. Тимура Фрунзе, д. 16 

Shpitser Ivan M., Maxillofacial Surgeon, University Clinic of the Scientific and Educational Institute; Postgraduate Student  

4, Dolgorukovskaya str., Moscow, 127006

16, Timur Frunze str., Moscow, 119034 

i@ishpitser.ruhttps://orcid.org/0000-0001-8344-988XВикентьевВ. В.VikentyevV. V.

Викентьев Вячеслав Викторович, доктор медицинских наук, профессор, зав. отделением функциональной диагностики, Университетская клиника Научно-образовательного института 

127006, Москва, ул. Долгоруковская, д. 4

Vikentyev Viacheslav V., Dr. of Sci (Med.), Professor, Head of the Department of Functional Diagnostics, University Clinic of the Scientific and Educational Institute

4, Dolgorukovskaya str., Moscow, 127006

vvvikentiev@mail.ruhttps://orcid.org/0000-0002-7783-0841ВедяеваА. П.VedyaevaA. P.

Ведяева Анна Петровна, доктор медицинских наук, доцент, зав. отделением хирургической стоматологией

119034, Москва, ул. Тимура Фрунзе, д. 16

Vedyaeva Anna P., Dr. of Sci (Med.), Docent, Head of the Department of Surgical Dentistry

16, Timur Frunze str., Moscow, 119034 

avedyaeva@yandex.ruhttps://orcid.org/0000-0002-1126-2159БольшаковМ. Н.BolshakovM. N.

Большаков Михаил Николаевич, кандидат медицинских наук, врач челюстнолицевой хирург отделения пластической и реконструктивной хирургии

119034, Москва, ул. Тимура Фрунзе, д. 16 

Bolshakov Mikhail N., Cand. of Sci (Med.), Maxillofacial Surgery of the Department of Plastic and Reconstructive Surgery

16, Timur Frunze str., Moscow, 119034

mnbolshakov@yandex.ruhttps://orcid.org/0000-0001-7256-3572КулаковО. Б.KulakovO. B.

Кулаков Олег Борисович, доктор медицинских наук, доцент, зав. отделением челюстно-лицевой хирургии, Университетская клиника Научно-образовательного института 

127006, Москва, ул. Долгоруковская, д. 4

Kulakov Oleg B., Dr. of Sci (Med.), Associate Professor, Head of the Department of Maxillofacial Surgery

4, Dolgorukovskaya str., Moscow, 127006

kulakov31@rambler.ruРоссийский университет медицины ; Центральный научно-исследовательский институт стоматологии и челюстно-лицевой хирургииРоссияRussian University of Medicine ; Central Research Institute of Stomatology and Maxillofacial SurgeryRussian FederationРоссийский университет медициныРоссияRussian University of MedicineRussian FederationЦентральный научно-исследовательский институт стоматологии и челюстно-лицевой хирургииРоссияCentral Research Institute of Stomatology and Maxillofacial SurgeryRussian Federation20250908202518436877Copyright © Шпицер И.М., Викентьев В.В., Ведяева А.П., Большаков М.Н., Кулаков О.Б., 20252025Шпицер И.М., Викентьев В.В., Ведяева А.П., Большаков М.Н., Кулаков О.Б.Shpitser I.M., Vikentyev V.V., Vedyaeva A.P., Bolshakov M.N., Kulakov O.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2516

Цель исследования – разработка алгоритма поиска перфорантных сосудов и предоперационного планирования дизайна лоскута переднебоковой поверхности бедра (ЛППБ) и лоскута на поверхностной артерии, огибающей подвздошную кость (ЛПАОПК), с использованием ультразвукового триплексного ангиосканирования (УТАС), и сравнение полученных данных с интраоперационной локализацией перфорантных сосудов.

Методы и материалы

Методы и материалы. С января 2023 по май 2024 г. в университетской клинике РУМ находились под наблюдением 8 пациентов с дефектами и новообразованиями челюстно-лицевой области, которым выполнялась предоперационная подготовка с двухсторонним УТАС мягких тканей переднебоковой поверхности бедра и паховой области. На уровне интересующих анатомических структур производилась оценка максимальной систолической скорости кровотока (максСС), индекса резистентности (ИР), локализации перфорантного сосуда и глубины его залегания. Всем пациентам в последующем было выполнено оперативное вмешательство, в процессе которого было проведено сравнение данных ангиоксанирования и интраоперационной картины. Подробно описан протокол УТАС для двух лоскутов с настройкой параметров аппарата ультразвуковой диагностики.

Результаты

Результаты. Таким образом, восьмерым пациентам была проведена реконструкция в области головы и шеи. Средний возраст пациентов был 41,25 лет (25–63 года), средний индекс массы тела (ИМТ) 26,14±2,47 кг/м2, было пересажено 5 ЛППБ и 3 ЛПАОПК. Средние данные максСС на уровне поверхностной артерии, огибающей подвздошную кость в ЛПАОПК, были равны 28,56±18,46 см/с, в ЛППБ на уровне нисходящей ветви латеральной огибающей бедренной артерии 49,86±15,02. Также описаны результаты измерения максСС и ИР в перфорантных сосудах на уровне глубокой и поверхностной фасции.

Заключение

Заключение. Триплексное ангиосканирование сосудов предоставляет как анатомическую, так и гемодинамическую информацию для донорских и реципиентных участков. Обучение хирурга методикам УТАС позволяет оператору до операции произвести тщательную оценку донорской зоны, что сократит непредвиденные ситуации интраоперационно.

The objective of the study was to develop an algorithm for searching perforator vessels and preoperative planning of the design of the anterolateral thigh perforator flap (ALT) and superficial circumflex iliac artery perforator flap (SCIP) using ultrasound triplex angioscanning (UTAS) and compare the data obtained with intraoperative localization of perforator vessels.

Methods and materials

Methods and materials. From January 2023 to May 2024, 8 patients with defects and neoplasms of the maxillofacial area, who underwent preoperative preparation with bilateral UTAS of soft tissues of the anterolateral thigh and groin area, were monitored at the University Clinic. At the level of the interested anatomical structures, the maximum systolic blood flow velocity (maxSBFV), resistance index (RI), perforator vessel localization and the depth of it were assessed. All patients underwent surgery soon, during which a comparison was made between angioscanning data and the intraoperative view. The UTAS protocol for two flaps with parameter settings of the ultrasound diagnostic device was described in detail.

Results

Results. Thus, eight patients underwent head and neck reconstruction. The average age of the patients was 41.25 years (25–63 years), the average body mass index (BMI) was 27.2 (26.14±2.47 kg/m2), 5 ALTPF and 3 SCIAPF were transplanted. The average maxSBFV values at the level of the superficial circumflex iliac artery in SCIAPF were 28.56±18.46 cm/s, in ALTPF at the level of the descending branch of the lateral circumflex femoral artery were 49.86±15.02 cm/s. The results of measuring maxSBFV and RI in perforator vessels at the level of deep and superficial fascia were also described.

Conclusion

Conclusion. Triplex angioscanning of blood vessels provides both anatomical and hemodynamic information for donor and recipient sites. The surgeon’s training in UTAS techniques allows the operator to carefully assess the donor area before surgery, which will reduce unpredictable situations intraoperatively.

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The authors declare that there are no conflicts of interest present.