Role of continuous wave vs pulse wave and color doppler in identifying arterial perforators of lower limb

Background Accurate identification of arterial perforators is essential for perforator flap surgery. While colour and pulsed wave Doppler provide anatomical and hemodynamic information, continuous wave Doppler is commonly used intra-operatively but lacks validation. Aim To compare the accuracy and utility of continuous wave Doppler with pulsed wave and colour Doppler in identifying lower limb arterial perforators. Methods In this prospective cross-sectional study, 100 healthy volunteers (18–60 years) underwent perforator mapping. Colour and pulsed wave Doppler (Samsung HS40) were used for localization, followed by continuous wave Doppler (Huntleigh DMX). Parameters included number, location, depth, calibre, and peak systolic velocity (PSV). Continuous wave signals were analysed using MATLAB. Results A total of 400 perforators were mapped. Most participants had 4–5 perforators per artery. Mean calibre was 1.51 mm and mean PSV was 32.4 cm/s. Continuous wave Doppler detected 84.8% of perforators and showed ~70% agreement with pulsed Doppler in identifying dominant perforators. Conclusion Continuous wave Doppler is a useful adjunct to duplex ultrasound but cannot replace colour and pulsed Doppler for anatomical mapping.