Pre- and Post-operative Sonological Assessment of Blood Flow and Vessel Characteristics in Axial Flaps

PURPOSE: A critical component of successful microsurgery is tissue flaps and their blood supply. Ensuring the patency of vascular anastomosis is essential for flap survival, with vascular insufficiency being a major complication. Color Doppler Sonography (CDS) is extensively utilized for the planning, designing, and monitoring of these flaps by evaluating their blood flow, velocity, and vessel characteristics. The study focuses on parameters such as vessel diameter, velocity, resistance index, and pulsatility index (PI). MATERIALS AND METHODS: A longitudinal descriptive study conducted in collaboration with the radiology department of Kasturba Medical College, Mangalore, monitored the hemodynamic changes in the vascular pedicle of axial flaps on postoperative days (PODs) 1, 7, and 21. The study found that the PI values decreased significantly postoperatively, indicating better perfusion in successful flaps, while higher PI values were associated with compromised flaps. RESULTS: The research identified a PI cutoff value of 3.67 on POD 7, with a sensitivity of 80% and specificity of 100% for predicting flap failure. This study underscores the importance of postoperative monitoring using CDS to predict vascular compromise and ensure timely intervention, ultimately improving the outcomes of flap-based reconstructive surgeries. CONCLUSION: This study concluded that Doppler monitoring of sequential changes in successful flaps can be routinely used to predict outcomes, allowing for the timely intervention and prevention of failures.