Mapping of Perforator Vessels by Color Doppler Ultrasonography for Elbow Region Reconstruction by Local/Regional Flaps

Introduction: The role of local perforator flaps in elbow soft tissue reconstruction increased in the last few years, as a consequence of their recognized advantages. The donor areas for those flaps are the distal arm and proximal forearm. The significant anatomic variability of the perforator vessels supplying the skin of the forearm and arm is well known. The assessment of perforator vessels by the use of hand held Doppler is incomplete and associated with an important number of false results, especially for upper limb. Color Doppler examination has a superior sensitivity and sensibility.

The aim of the study is the assessment of the perforator vessels from the distal half of the arm and proximal half of the forearm by the use of Color Doppler in terms of localization, number, type, and caliber. The final goal of the study is the development of detailed maps of the target regions.

Methodology and Material: The study was performed using ultrasound machine with variable frequency 9-14 MHz linear high resolution transducer. Both arms and forearms of 10 healthy volunteers were examined. One line from lateral to medial humeral epicondyle was traced, and another one at 90°, on the middle of the first one. A chartesian tow-dimensional system was designed. Four regions with 4 quadrants were made. The point where perforator pierces the deep fascia was noted on the individual map of each subject, in centimeters, reported to the Cartesian system described. All individual maps were superposed and final volar and dorsal maps were made. Some groups of perforators were identified. The centers of the groups were determined by the K-Means Cluster Algorithm.

Results: On the target regions, 395 perforator vessels are identified (mean 19, 75 perforators/limb), most of them (63,79%) being located on the volar regions. On the distal half of the volar arm, 39% of the perforator vessels are identified. Most of the perforator vessels from volar regions are septocutaneous. Several 51 perforator vessels have a Doppler caliber bigger than 1 mm and are mainly located on the volar side of the target regions. On the volar map 3 groups of perforators were identified, with center coordinates (-0,46; 8,15), (0,74;-0,45), (-0,49; -9,81). On the dorsal map, 2 groups with centers' coordinates (0,93; 7,10) and (-0,55; -2,63).

Conclusions: On the target regions was identified at least one perforator vessel able to support flaps for elbow soft tissue reconstruction. Perforator flaps are safe and versatile microsurgical-non microvascular solution in elbow soft tissue reconstruction, the described maps could be considered as valuable clinical tools in planning the flaps. This custom concept of mapping could be applied for other regions of the body, especially upper and lower limbs.