EVALUATION OF FASCIOCUTANEOUS PERFORATORS USING COLOR DUPLEX IMAGING

Technological improvements in conventional ultrasound, including color duplex imaging, have greatly facilitated the evaluation of vascular-r elated problems for virtually every specialty. Higher-frequency transd ucers now permit the scanning of superficial depths beneath the skin s urface with high sensitivity for an analysis specific to the microcirc ulation. This attribute has already been recognized as a valuable tool for the preoperative mapping of musculocutaneous perforators. A logic al extension of this capability would be for the localization and cali bration of deep fascial perforators, which may have even greater clini cal significance because anomalies at this level are more the rule rat her 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 releva nt cutaneous perforators. All fasciocutaneous flap subtypes were inclu ded. If feasible at the time of flap elevation, all identified perfora tors were dissected and measured. All were found at the exact site as marked preoperatively, and their diameter closely approximated that pr edicted. The occasional unanticipated presence in vivo of minor perfor ators suggests that color duplex imaging may not be reliable for fasci al 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 perforator s in a given region. From such data, the definition of new and more re liable fasciocutaneous flap donor territories should be forthcoming. T he preoperative identification of solitary perforators of dimensions s ufficient to permit safe microsurgical tissue transfer in many circums tances will obviate any anxiety or need to sacrifice a larger source v essel.