EVALUATION OF FASCIOCUTANEOUS PERFORATORS USING COLOR DUPLEX IMAGING

Technological improvements in conventional ultrasound, including color duplex imaging, have greatly facilitated the evaluation of vascular-related problems for virtually every specialty. Higher-frequency transducers now permit the scanning of superficial depths beneath the skin surface with high sensitivity for an analysis specific to the microcirculation. This attribute has already been recognized as a valuable tool for the preoperative mapping of musculocutaneous perforators. A logical extension of this capability would be for the localization and calibration of deep fascial perforators, which may have even greater clinical significance because anomalies at this level are more the rule rather than the exception. Over the preceding 10-month period, all eight elective fasciocutaneous flaps performed in eight patients had initial scans using color duplex imaging to identify and calibrate all relevant cutaneous perforators. All fasciocutaneous flap subtypes were included. If feasible at the time of flap elevation, all identified perforators were dissected and measured. All were found at the exact site as marked preoperatively, and their diameter closely approximated that predicted. The occasional unanticipated presence in vivo of minor perforators suggests that color duplex imaging may not be reliable for fascial perforators less than 0.5 mm in diameter. Since perforator caliber qualitatively is a major determinant of flow color duplex imaging can then objectively establish a hierarchy of the importance of perforators in a given region. From such data, the definition of new and more reliable fasciocutaneous flap donor territories should be forthcoming. The preoperative identification of solitary perforators of dimensions sufficient to permit safe microsurgical tissue transfer in many circumstances will obviate any anxiety or need to sacrifice a larger source vessel.