Role of Colour Doppler Ultrasound in Planning Pedicled Perforator Flaps for Lower Limb Reconstruction: A Case Series

Coverage of lower limb defects is a common challenge in reconstructive surgery. Flaps are often required, and perforator flaps are widely used. Preoperative mapping of perforators and donor site morbidity are key concerns. Traditional modalities used to locate perforators include computed tomographic angiography, magnetic resonance imaging and angiography, and handheld Doppler devices. With advancements in duplex ultrasound, minute details of the arterial system and its perforators can now be assessed preoperatively and utilised in surgical planning for lower limb reconstruction. A total of 17 patients with lower limb defects were reconstructed using pedicled perforator flaps guided by Colour Doppler Ultrasound (CDU). Fourteen patients were male and three were female. The mean age was 36±12.4 years (range: 13-57 years), and the mean follow-up period was six months. All defects were due to trauma. The average defect size was 33.6 cm² (range: 12-200 cm²). The choice of perforator flap was based on the best adjacent perforator identified using colour Doppler ultrasound. The mean perforator diameter was 1.4±0.2 mm (range: 1.1-1.8 mm), and the mean peak systolic blood flow velocity was 24.8±8.08 cm/s (range: 12-37 cm/s). The procedure was successful in 16 patients (94%). Colour Doppler ultrasound is a useful tool for identifying perforators for pedicled perforator flaps in lower limb reconstruction. Further studies with larger sample sizes are needed to establish linear correlations.