Preoperative Color Doppler Assessment in Planning of Gluteal Perforator Flaps

Abstract

Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores.

Use of Perforator-Based Fasciocutaneous Flaps for Pressure Sore Reconstruction: Single-Perforator-Based Versus Multiple-Perforator-Based Flaps

“…Many modalities are available for preoperative perforator mapping, such as Doppler ultrasonography, color Doppler ultrasonography, CT angiography, and magnetic resonance angiography, and each has its advantages and disadvantages [34][35][36][37][38][39][40][41]. Handheld Doppler ultrasonography is convenient, quick, and inexpensive.…”

Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern

“…Furthermore, the MDCT is not suitable for detecting perforators running through the subcutaneous tissue layers. 5 The color Doppler ultrasound (CDU) has been widely performed as a preoperative examination method for a variety of perforator flap surgeries, 6 including anterolateral thigh flaps, 7 deep inferior epigastric perforator flaps, 8 gluteal perforator flaps, 9 and sural artery perforator flaps. 10 In this report, we describe the usefulness of the preoperative CDU in harvesting LTA perforator flaps, and we analyze the courses and diameters of perforators running through this area.…”

Maximizing the Use of the Handheld Doppler in Autologous Breast Reconstruction

“…These include but are not limited to color duplex sonography, computerized tomographic angiography (CTA), magnetic resonance angiography (MRA), and fluorescent angiography. [2][3][4][5][6][7][8] Despite the benefits of these newer technologies, downsides related to cost, time, and interobserver variability have resulted in reluctance on the part of some surgeons to adopt these technologies. Instead, they have relied on classical techniques to define the vascular anatomy, such as the handheld acoustic Doppler.…”