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Review of surgeon-performed point-of-care ultrasound imaging in plastic surgery

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Abstract

Background

Ultrasound scanning (USS) is a well-established imaging modality with widespread clinical applications; however, it is still broadly underused by plastic surgeons. This review aims to understand the breadth of potential uses for surgeon-led point-of-care USS in plastic surgery.

Methods

A review of the literature was conducted by extracting articles from Medline, Embase, Google Scholar and Scopus databases relevant to USS use by plastic surgeons. Included articles were divided into themes corresponding to major fields of plastic surgery and their findings were extracted and summarised.

Results

Major themes identified were “Upper limb”, “Microsurgery”, “Breast”, “Skin and soft tissues”, “Aesthetics” and “Regional anaesthesia”. USS was shown to have significant benefits in diagnostic, pre-operative planning and post-operative monitoring across the themes identified. Amongst others, its use as a bedside modality was particularly highlighted in evaluating structural hand injuries, pre-operative perforator map** and post-operative monitoring in buried free flaps, clinic evaluation of breast implants for capsular contractures and ruptures, assessment of soft tissue infections such as necrotizing fasciitis and administration of regional blocks in the limbs and body such as transverse abdominal plane block as part of large abdominal surgeries.

Conclusions

Plastic surgeon–operated USS appears to have clear benefits in a wide range of uses within the field. With such a broad scope, it is clear that the modern plastic surgeons would benefit from proficiency in its use as a part of their repertoire and that its use should be taught to current trainees.

Level of Evidence: Not ratable

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References

  1. Bollard SM, Kelly B, McDermott C, Potter S (2021) The use of point of care ultrasound in hand surgery. J Hand Surg [Am] 46:602–607

    Article  Google Scholar 

  2. Marsh-Feiley G, Eadie L, Wilson P (2018) Telesonography in emergency medicine: a systematic review. PLoS One 13:e0194840

    Article  PubMed  PubMed Central  Google Scholar 

  3. McBeth PB, Hamilton T, Kirkpatrick AW (2010) Cost-effective remote iPhone-teathered telementored trauma telesonography. J Trauma 69:1597–1599

    PubMed  Google Scholar 

  4. Mortada H, Al Mazrou F, Alghareeb A, AlEnezi M, Alalawi S, Neel OF (2022) Overview of the role of ultrasound imaging applications in plastic and reconstructive surgery: is ultrasound imaging the stethoscope of a plastic surgeon? A narrative review of the literature. Eur J Plast Surg. https://doi.org/10.1007/s00238-022-01981-y

  5. Oni G, Chow W, Ramakrishnan V, Griffiths M (2018) Plastic surgeon–led ultrasound. Plast Reconstr Surg 141:300e

    Article  CAS  PubMed  Google Scholar 

  6. Safran T, Gorsky K, Viezel-Mathieu A, Kanevsky J, Gilardino MS (2018) The role of ultrasound technology in plastic surgery. J Plast Reconstr Aesthet Surg 71:416–424

    Article  PubMed  Google Scholar 

  7. Budovec JJ, Sudakoff GS, Dzwierzynski WW, Matloub HS, Sanger JR (2006) Sonographic differentiation of digital tendon rupture from adhesive scarring after primary surgical repair. J Hand Surg [Am] 31:524–529

    Article  Google Scholar 

  8. Bekhet CNH, Ghaffar MKA, Nassef MA, Khattab RT (2021) Role of ultrasound in flexor tendon injuries of the hand: a new insight. Ultrasound Med Biol 47:2157–2166

    Article  PubMed  Google Scholar 

  9. Sun S, Geannette C, Braun N, Wolfe SW, Endo Y (2022) Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures. Skelet Radiol 51:1463–1472

    Article  Google Scholar 

  10. Handschak T, Hofmann G, Braunschweig R, Tamouridis G, Siemers F (2022) Establishing a standardized diagnostic procedure for sonographic imaging and evaluation of the scapholunate ligament. Handchir Mikrochir Plast Chir 54:28–37

    PubMed  Google Scholar 

  11. Chen P, Wang L, Pong Y, Hsin Y, Liaw M, Chiang C (2018) Effectiveness of ultrasound-guided vs direct approach corticosteroid injections for carpal tunnel syndrome: a double-blind randomized controlled trial. J Rehabil Med. https://doi.org/10.2340/16501977-2308

  12. Tsu**o S, Seki Y, Maehara M, Shirasawa S (2022) Ulnar nerve injury following distal radius fracture assessed by ultrasonography: management of an ulnar nerve lesion. J Hand Surg Asian Pac Vol 27:408–412

    Article  PubMed  Google Scholar 

  13. Fort NM, Victoria C, Ko L, Wolfe SW, Lee SK, Nwawka OK (2022) High resolution ultrasound for the evaluation of radial nerve pathology adjacent to metallic hardware. J Orthop Res. https://doi.org/10.1002/jor.25278

  14. Al-Hourani K, Gamble D, Armstrong P, O’Neill G, Kirkpatrick J (2018) The predictive value of ultrasound scanning in certain hand and wrist conditions. J Hand Surg Asian Pac Vol 23:76–81

    Article  PubMed  Google Scholar 

  15. Cen C, Cao Y, Zhang Y, Hu C, Luo C (2022) Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures. J Orthop Surg Res 17:260

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bianchi S, Mauler F (2022) Ultrasound appearance of in vitro nerve allografts and conduits for peripheral nerve reconstruction. J Ultrasound Med 41:763–771

    Article  PubMed  Google Scholar 

  17. Gu S, Zhao Q, Yao J, Zhang L, Xu L, Chen W, Gu Y, Xu J (2022) Diagnostic ability of ultrasonography in brachial plexus root injury at different stages post-trauma. Ultrasound Med Biol 48:1122–1130

    Article  PubMed  Google Scholar 

  18. McDonagh C, Alexander M, Kane D (2015) The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology 54:9–19

    Article  CAS  PubMed  Google Scholar 

  19. Gervasio A, Stelitano C, Bollani P, Giardini A, Vanzetti E, Ferrari M (2020) Carpal tunnel sonography. J Ultrasound 23:337–347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Rigoni M, Raggi M, Speri L (2021) A new “denervation” technique for painful arthritic wrist. J Wrist Surg 10:359–366

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhao W, Wang G, Chen B, **ao J, Sun X, Wu T, Ren H, Li X (2019) The value of ultrasound for detecting hand fractures: a meta-analysis. Medicine 98:e17823

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hayashi A, Visconti G, Giacalone G, Hayashi N, Yoshimatsu H (2022) Recent advances in ultrasound technology: ultra-high frequency ultrasound for reconstructive supermicrosurgery. J Reconstr Microsurg 38:193–199

    Article  PubMed  Google Scholar 

  23. Cho M-J, Kwon JG, Pak CJ, Suh HP, Hong JP (2020) The role of duplex ultrasound in microsurgical reconstruction: review and technical considerations. J Reconstr Microsurg 36:514–521

    Article  PubMed  Google Scholar 

  24. Chang BW, Luethke R, Berg WA, Hamper UM, Manson PN (1994) Two-dimensional color Doppler imaging for precision preoperative map** and size determination of TRAM flap perforators. Plast Reconstr Surg 93:197–200

    Article  CAS  PubMed  Google Scholar 

  25. Pereira N, Lee YH, Suh Y, Choi DH, Suh HS, Jeon JY, Hong JPJ (2018) Cumulative experience in lymphovenous anastomosis for lymphedema treatment: the learning curve effect on the overall outcome. J Reconstr Microsurg 34:735–741

    Article  PubMed  Google Scholar 

  26. Kehrer A, Sachanadani NS, da Silva NPB, Lonic D, Heidekrueger P, Taeger CD, Klein S, Jung EM, Prantl L, Hong J-P (2020) Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg 73:1081–1090

    Article  PubMed  Google Scholar 

  27. Homsy C, McCarthy ME, Lim S, Lindsey JT Jr, Sands TT, Lindsey JT Sr (2020) Portable color-flow ultrasound facilitates precision flap planning and perforator selection in reconstructive plastic surgery. Ann Plast Surg 84:S424–S430

    Article  CAS  PubMed  Google Scholar 

  28. Cariati P, Cabello Serrano A, Monsalve Iglesias F, Roman Ramos M, Fernandez Solis J, Martinez Lara I (2019) Unfavorable outcomes in microsurgery: possibilities for improvement. J Plast Surg Hand Surg 53:279–287

    Article  PubMed  Google Scholar 

  29. Gonzalez J, Gardikiotis I, Ruiz-Moya A, Fontdevila J, Weshahy O, Palacin J, Vinals J, Hong JP (2021) Duplex echography as an adjuvant tool to clinical examination to detect early postoperative free flap vascular compromise. Microsurgery 41:109–118

    Article  PubMed  Google Scholar 

  30. Elmelegy N, Shokr T, Osama M (2019) Nipple-areola complex ischemia or necrosis in freestyle perforator flap reduction mammoplasty operations. Aesthet Plast Surg 43:1506–1514

    Article  Google Scholar 

  31. McKernan CD, Vorstenbosch J, Chu JJ, Nelson JA (2022) Breast implant safety: an overview of current regulations and screening guidelines. J Gen Intern Med 37:212–216

    Article  PubMed  Google Scholar 

  32. Oranges T, Janowska A, Scatena C, Faita F, Lascio ND, Izzetti R, Fidanzi C, Romanelli M, Dini V (2022) Ultra-high frequency ultrasound in melanoma management: a new combined ultrasonographic-histopathological approach. J Ultrasound Med. https://doi.org/10.1002/jum.16096

  33. Cardona-Castro W, Zuluaga-Gómez M, González-Arroyave D, Ardila CM (2022) Accuracy of point-of-care ultrasonography in the diagnosis of necrotizing fasciitis: a case report. Biomed Rep 17:98

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cernakova M, Hobusch GM, Amann G, Funovics PT, Windhager R, Panotopoulos J (2021) Diagnostic accuracy of ultrasound-guided core needle biopsy versus incisional biopsy in soft tissue sarcoma: an institutional experience. Sci Rep 11:17832

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Del Vecchio D, Kenkel JM (2022) Practice advisory on gluteal fat grafting. Aesthet Surg J 42:1019–1029

    Article  PubMed  Google Scholar 

  36. Desyatnikova S (2022) Ultrasound-guided temple filler injection. Facial Plast Surg Aesthet Med 24:501–503

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cuccia G, Gagliardo CM, Romeo M, Di Trapani B (2022) Hybrid mastopexy: improving outcomes on implant-based augmentation mastopexy with fat. Eur J Plast Surg 45:79–87

    Article  Google Scholar 

  38. Sforza M, Spear S (2021) Hybrid implant and grafted fat breast augmentation: designing the pathway to a future with breasts free of silicone breast implants. Aesthet Surg J 41:NP1473–NP1485

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lee J, Park HY, Kim WW, Park CS, Lee RK, Yang JD, Lee JS, Jung JH (2019) Comparison between ultrasound-guided aspiration performed using an intravenous cannula or a conventional needle in patients with peri-prosthetic seroma. Medicine 98:e18511

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hivelin M, Wyniecki A, Plaud B, Marty J, Lantieri L (2011) Ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after breast reconstruction by DIEP flap. Plast Reconstr Surg 128:44–55

    Article  CAS  PubMed  Google Scholar 

  41. Straughan DM, Lindsey JT, McCarthy M, Legendre D, Lindsey JT (2021) Enhanced recovery after surgery protocol with ultrasound-guided regional blocks in outpatient plastic surgery patients leads to decreased opioid prescriptions and consumption. Aesthet Surg J. https://doi.org/10.1093/asj/sjab137

  42. Wheble GAC, Tan EKH, Turner M, Durrant CAT, Heppell S (2013) Surgeon-administered, intra-operative transversus abdominis plane block in autologous breast reconstruction: a UK hospital experience. J Plast Reconstr Aesthet Surg 66:1665–1670

    Article  PubMed  Google Scholar 

  43. Homsy C, Lindsey JT (2019) Regional anesthetic blocks in plastic surgery using portable ultrasound: a simplified approach. Ann Plast Surg 82:S374

    Article  CAS  PubMed  Google Scholar 

  44. Battista C, Krishnan S (2023) Pectoralis nerve block. In: StatPearls. StatPearls Publishing, Treasure Island (FL)

    Google Scholar 

  45. Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF (2015) Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd006459.pub3

  46. Pester JM, Hendrix JM, Varacallo M (2023) Brachial Plexus Block Techniques, in: StatPearls. StatPearls Publishing, Treasure Island (FL)

    Google Scholar 

  47. Jung EM, Dinkel J, Verloh N, Brandenstein M, Stroszczynski C, Jung F, Rennert J (2021) Wireless point-of-care ultrasound: first experiences with a new generation handheld device. Clin Hemorheol Microcirc 79:463–474

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Tsou P-Y, Wang Y-H, Ma Y-K, Deanehan JK, Gillon J, Chou EH, Hsu T-C, Huang Y-C, Lin J, Lee C-C (2019) Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: a systematic review and meta-analysis. Am J Emerg Med 37:1760–1769

    Article  PubMed  Google Scholar 

  49. Mijuskovic B, Tremp M, Heimer MM, Boll D, Aschwanden M, Zeindler J, Kurzeder C, Schaefer DJ, Haug MD, Kappos EA (2019) Color Doppler ultrasound and computed tomographic angiography for perforator map** in DIEP flap breast reconstruction revisited: a cohort study. J Plast Reconstr Aesthet Surg 72:1632–1639

    Article  CAS  PubMed  Google Scholar 

  50. Miller JP, Carney MJ, Lim S, Lindsey JT (2018) Ultrasound and plastic surgery: clinical applications of the newest technology. Ann Plast Surg 80:S356–S361

    Article  CAS  PubMed  Google Scholar 

  51. McAlister S, McGain F, Petersen M, Story D, Charlesworth K, Ison G, Barratt A (2022) The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac 24:100459

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. The Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1FR, UK

    Claire McGregor

  2. Manchester University Foundation NHS Trust, Oxford Road, Manchester, M13 9WL, UK

    Patrick Tabet

  3. University Hospitals Plymouth, Derriford Road, Plymouth, PL6 8DH, UK

    Lara Money

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  1. Claire McGregor
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Correspondence to Claire McGregor.

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Claire McGregor and Patrick Tabet are joint first author.

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McGregor, C., Tabet, P. & Money, L. Review of surgeon-performed point-of-care ultrasound imaging in plastic surgery. Eur J Plast Surg 47, 5 (2024). https://doi.org/10.1007/s00238-023-02145-2

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