title: Changes in donor site selection in lower limb free flap reconstructions by integrating duplex ultrasonography in the preoperative design.
abstract: BACKGROUND
  The flap selection criteria in lower extremity reconstruction are based on the wound characteristics and donor site morbidity. We hypothesized that the decision-making could be influenced by integrating Duplex Ultrasound (DU) in the preoperative design.
  
  
  METHODS
  We retrospectively reviewed data on patients who underwent lower-extremity microvascular soft-tissue reconstruction at our institution by the same surgeon. In Group A, DU was integrated in the preoperative design of the microsurgical reconstruction, whilst in Group B the choice of free flap donor site and level of anastomosis were based on clinical criteria only.
  
  
  RESULTS
  A total of 48 microvascular reconstructions were recorded. DU was used preoperatively in 20-patients, whilst in 28-patients flap selection was based on clinical criteria. There was a significant decrease in perforator flap (45% over 64%) and a significant increase in muscle flap preference (55% over 32%) in the DU-group. There was no significant difference (10% over 11%) in the donor site selection with considerable morbidity. There was no flap failure in the DU-group, whilst 3 flaps failed in the second-group (p< 0.05, χ(2)-test). Wound healing was significantly faster in the DU-group (21±3 days) compared to 37±3 days in the other group (p< 0.05, t-test).
  
  
  CONCLUSIONS
  Preoperative ultrasound studies moved flap preference towards chimeric and muscle flaps with low morbidity to match the three-dimensional defect and to promote healing.
  
  
  BACKGROUND
  lower limb reconstruction; free flap; donor site; duplex ultrasound.
authors.forename: A
authors.initials: A
authors.lastname: Gravvanis
authors.forename: K
authors.initials: K
authors.lastname: Kateros
authors.forename: K
authors.initials: K
authors.lastname: Apostolou
authors.forename: D
authors.initials: D
authors.lastname: Karakitsos
authors.forename: D
authors.initials: D
authors.lastname: Tsoutsos
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D057234:Preoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D014945:Wound Healing