Clinical utility of colour flow Doppler ultrasonography in planning anterolateral thigh flap harvest.
BACKGROUND
The anatomic variability of cutaneous perforators contributes to the technical challenges of anterolateral thigh (ALT) free flap harvest. The objective of this study was to assess the accuracy and clinical utility of preoperative colour flow Doppler (CFD) ultrasonography in evaluating planned ALT flap donor sites.


METHODS
A prospective study of the infrainguinal vasculature (profunda femoris and lateral circumflex femoral arteries) in 16 consecutive patients scheduled for ALT free flap transfer for reconstruction of head and neck surgical defects was undertaken. All patients underwent CFD ultrasonography. The location of perforators and the thigh thickness determined by CFD ultrasonography were correlated with the actual intraoperative findings using a scatter plot and paired t-test.


RESULTS
Two patients were diagnosed with bilateral silent infrainguinal claudication, which precluded safe use of the ALT donor site. In two other patients, the planned ALT donor site ipsilateral to the defect was not used because of silent infrainguinal claudication diagnosed by CFD ultrasonography. In the 14 patients who underwent ALT flap harvest, CFD ultrasonography identified 48 perforators, which coincided with 43 actual perforators found intraoperatively. CFD ultrasonography demonstrated a statistically significant correlation with the actual perforator locations (Spearman coefficient .76; p = .55). Although CFD ultrasonography tended to underestimate flap thickness, there was a statistically significant correlation (Spearman coefficient .94; p ≤ .0001) with the actual flap thickness.


CONCLUSIONS
CFD ultrasonography has clinical utility in facilitating decision making and planning ALT flap harvest.
Patel
Rajan S
RS
Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre/Odette Cancer Centre, and University of Toronto, Toronto, ON. drrajanspatel@gmail.com
Higgins
Kevin M
KM
Enepekides
Danny J
DJ
Hamilton
Paul A
PA
D001783:Blood Flow Velocity / Q000502:physiology*; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000637:transplantation; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D015203:Reproducibility of Results; D013524:Surgical Flaps; D013848:Thigh; D020858:Tissue and Organ Harvesting / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000706:statistics & numerical data*