J Reconstr Microsurg 2009; 25(6): 377-381
DOI: 10.1055/s-0029-1220860
© Thieme Medical Publishers

Attributes and Shortcomings of Acoustic Doppler Sonography in Identifying Perforators for Flaps from the Lower Extremity

Geoffrey G. Hallock1 , 2
  • 1Division of Plastic Surgery, Sacred Heart Hospital and The Lehigh Valley Hospitals, Allentown, Pennsylvania
  • 2St. Luke's Hospital, Bethlehem, Pennsylvania
Further Information

Publication History

Publication Date:
23 April 2009 (online)

ABSTRACT

The preoperative identification of perforators can facilitate the appropriate design of perforator flaps from the lower extremity. Although computed tomographic arteriography can now be considered the gold standard in this regard, this technology is not universally available or inexpensive, with a nonnegligible risk from radiation exposure. An old standby, the ubiquitous acoustic Doppler sonography, still has a role as an alternative, despite perhaps its too high sensitivity and low specificity. Regardless of the modality employed, the efficacious harvest of a perforator flap will still require constant vigilance during its dissection due to anatomic anomalies of the course of these perforators, which is the expected norm.

REFERENCES

  • 1 Milton S H. Pedicled skin-flaps: the fallacy of the length:width ratio.  Br J Surg. 1970;  57 502-508
  • 2 O'Brien C J, Harris J P, May J. Doppler ultrasound in the evaluation of experimental microvascular grafts.  Br J Plast Surg. 1984;  37 596-601
  • 3 Jones B M, Greenhalgh R M. The use of the ultrasound Doppler flowmeter in reconstructive microvascular surgery.  Br J Plast Surg. 1983;  36 245-253
  • 4 Hallock G G. Doppler sonography and color duplex imaging for planning a perforator flap.  Clin Plast Surg. 2003;  30 347-357
  • 5 Taylor G I, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications.  Br J Plast Surg. 1990;  43 1-16
  • 6 Hallock G G. Color duplex imaging for identifying perforators prior to pretransfer expansion of fasciocutaneous free flaps.  Ann Plast Surg. 1994;  32 595-601
  • 7 Hallock G G. Evaluation of fasciocutaneous perforators using color duplex imaging.  Plast Reconstr Surg. 1994;  94 644-651
  • 8 Tsukino A, Kurachi K, Inamiya T, Tanigaki T. Preoperative color Doppler assessment in planning of anterolateral thigh flaps.  Plast Reconstr Surg. 2004;  113 241-246
  • 9 Sharma R K, Tuli P. Is there any need to localize the perforator of the anterolateral thigh flap?.  Plast Reconstr Surg. 2007;  119 2328-2329
  • 10 Masiá J, Larrañaga J, Clavero J A, Vives L, Pons G, Pons J M. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap, our experience in 162 cases.  Ann Plast Surg. 2008;  60 29-36
  • 11 Moscatiello F, Masiá J, Carrera A, Clavero J A, Larrañaga J R, Pons G. The “propeller” distal anteromedial thigh perforator flap. Anatomic study and clinical applications.  J Plast Reconstr Aesthet Surg. 2007;  60 1323-1330
  • 12 Rozen W M, Phillips T J, Ashton M W, Stella D L, Gibson R N, Taylor G I. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound.  Plast Reconstr Surg. 2008;  121 9-16
  • 13 Rozen W M, Ashton M W, Stella D L, Phillips T J, Grinsell D, Taylor G I. The accuracy of computed tomographic angiography for mapping the perforators of the deep inferior epigastric artery: a blinded, prospective cohort study.  Plast Reconstr Surg. 2008;  122 1003-1009
  • 14 Imai R, Matsumura H, Tanaka K, Uchida R, Watanabe K. Comparison of Doppler sonography and multidetector-row computed tomography in the imaging findings of the deep inferior epigastric perforator artery.  Ann Plast Surg. 2008;  61 94-98
  • 15 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap.  Plast Reconstr Surg. 2006;  118 928-933
  • 16 Einstein A J, Henzlova M, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography.  JAMA. 2007;  298 317-323
  • 17 Brenner D J, Elliston C D. Estimated radiation risks potentially associated with full-body CT screening.  Radiology. 2004;  232 735-738
  • 18 Brenner D J, Hall E J. Computed tomography—an increasing source of radiation exposure.  N Engl J Med. 2007;  357 2277-2284
  • 19 Giunta R E, Geisweid A, Feller A M. The value of preoperative Doppler sonography for planning free perforator flaps.  Plast Reconstr Surg. 2000;  105 2381-2386
  • 20 Blondeel P N, Beyens G, Verhaege R et al.. Doppler flowmetry in the planning of perforator flaps.  Br J Plast Surg. 1998;  51 202-209
  • 21 Mun G H, Jeon B J. An efficient method to increase specificity of acoustic Doppler sonography for planning a perforator flap: perforator compression test.  Plast Reconstr Surg. 2006;  118 296-297
  • 22 Hallock G G. A primer of schematics to facilitate the design of the preferred muscle perforator flaps.  Plast Reconstr Surg. 2009;  123(3) 1107-1115
  • 23 Blondeel PN, Morris SF, Hallock GG, Neligan PC Perforator Flaps: Anatomy, Technique, & Clinical Applications. St. Louis; Quality Medical Publishing 2006
  • 24 Sharma R K, Tuli P. Is there any need to localize the perforator of the anterolateral thigh flap?.  , (Reply) Plast Reconstr Surg. 2007;  119 2329-2330
  • 25 Hallock G G. Further clarification of the Nomenclature for compound flaps (CME).  Plast Reconstr Surg. 2006;  117 151e-160e

Geoffrey G HallockM.D. 

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Suite 306, Allentown, Pennsylvania, 18103

Email: pbhallock@cs.com