title: The hand held Doppler device for the detection of perforators in reconstructive surgery: what you hear is not always what you get.
abstract: BACKGROUND
  Perforator-based flaps have become indispensable in the treatment of burn scars. Pre-operative perforator mapping is often performed by use of the hand held Doppler device, partly due to its convenience and the low costs. We expected to find sufficient evidence in literature to support the use of the device, however available literature showed a distinct lack of clinimetric studies that adequately tested the reliability.
  
  
  METHODS
  To assess reliability, perforator locations were mapped independently by two clinicians using an 8MHz Doppler device. In healthy volunteers the elbow region or the peri-umbilical region were randomly chosen to be the measurement areas of predefined squares (7cm×7cm). Subsequently, the perforators within the area were mapped with Duplex to establish the validity by means of the positive predictive value.
  
  
  RESULTS
  20 volunteers were included. The hand held Doppler technique showed moderate reliability with a mean Dice coefficient of 0.56. Also, poor validity was found expressed by a mean positive predictive value of 55%.
  
  
  CONCLUSIONS
  Surprisingly, this study has shown that performance of the hand held Doppler device was moderate. The Doppler should not be used alone for the detection of perforators.
authors: Association of Dutch Burn Centers, Beverwijk, The Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; MOVE Research Institute, VU University of Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors: Carlijn M
authors: CM
authors: Stekelenburg
authors: Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
authors: Pia M D G
authors: PM
authors: Sonneveld
authors: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors: Mark-Bram
authors: MB
authors: Bouman
authors: Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
authors: Martijn B A
authors: MB
authors: van der Wal
authors: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors: Dirk L
authors: DL
authors: Knol
authors: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Henrica C W
authors: HC
authors: de Vet
authors: Association of Dutch Burn Centers, Beverwijk, The Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; MOVE Research Institute, VU University of Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: ppmvanzuijlen@me.com.
authors: Paul P M
authors: PP
authors: van Zuijlen
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D004550:Elbow / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019095:Point-of-Care Systems; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D015203:Reproducibility of Results; D012867:Skin / Q000098:blood supply*; D016038:Skin Transplantation / Q000379:methods*; D018608:Ultrasonography, Doppler; D014472:Umbilicus / Q000000981:diagnostic imaging
keywords: Burn scar contracture; Detection perforator; Hand held Doppler device; Planning perforator flaps; Reliability; Validity