Usefulness of Pulsed Wave Doppler Ultrasonography for Evaluating Recipient Vessels of Free Flap Reconstruction in Patients With Severe Extremity Trauma: A Preliminary Report

Abstract

Background

In cases of severe extremity trauma treated with the ‘internal fixation for fractures and flap’ technique, successful soft tissue reconstruction requires selecting recipient vessels that avoid the zone of injury. Pulsed wave Doppler ultrasonography has been proposed as a useful tool for the preoperative evaluation of recipient vessels in plastic surgeries. This report aimed to present the preliminary experience of pulsed wave Doppler ultrasonography in traumatic disease.

Methods

This report included 14 free flaps from 13 patients with severe extremity trauma. The flaps included nine free latissimus dorsi flaps (two combined with serratus anterior flaps) and five free anterolateral thigh flaps. The recipient vessels included the posterior tibial artery (n = 8), anterior tibial artery (n = 2), perforator of the hypoplastic posterior tibial artery (n = 1), brachial artery (n = 1), radial artery (n = 1), and the ulnar artery (n = 1). Preoperative pulsed Doppler ultrasonography was used to evaluate the recipient vessels and the vascular anastomosis site was determined based on the modified waveform classification and maximum flow velocity (V_max), as described by Ogino et al. The following variables were analyzed: modified vascular waveform classification at the anastomosis site, V_max, presence of posttraumatic vessel disease, and flap survival rate.

Results

The modified vascular waveform classification at the anastomotic site was D-1a in seven cases, D-1b in four cases, and D-2 in three cases, with an average V_max of 27.4 cm/s (range: 16.2–40.0 cm/s). Post-traumatic vessel disease was not observed in any of the cases. The flap survival rate was 100%.

Conclusion

Pulsed wave Doppler ultrasonography is a valuable tool for the preoperative evaluation of recipient vessels in free flap reconstruction for severe extremity trauma. Its use can help ensure the optimal selection of recipient vessels, contributing to high flap survival rates.