Preoperative high-frequency color Doppler ultrasound assessment of the blood vessels of the fibular myocutaneous flap

Objective: The fibular myocutaneous flap is a classic flap used to reconstruct oral and maxillofacial defects. This study aimed to evaluate the effectiveness of high-frequency color Doppler ultrasound in detecting the blood vessels in the fibular myocutaneous flap, ana-lyze the influence of variations in the peroneal vessels and perforating peroneal arteries on the surgical design, and explore the value of this technology in preoperatively assessing the blood vessels of the fibular myocutaneous flap.Methods: Twenty-five patients with mandibular disease or defect underwent preoperative eval-uation of the blood vessels of the calf by high-frequency color Doppler ultrasound. The inner diameter and peak systolic velocity (PSV) of the peroneal arteries and veins and the perforat-ing peroneal arteries were compared between different groups. The consistency between the perforating peroneal arteries marked by ultrasonography and the intraoperative findings was analyzed.Results: The initial segment of the peroneal artery had a larger inner diameter ( p < 0.001) and lower PSV ( p < 0.05) than the middle segment. The perforating peroneal arteries were mainly distributed in the middle of the fibula. The inner diameter of the perforating peroneal artery was larger in men than in women ( p < 0.05). In comparison with surgical exploration as the gold standard, high-frequency color Doppler ultrasound results showed good consis-tency (Kappa= 0.684, 95% CI: 0.512-0.856, p< 0.001), with a sensitivity of 89.36%, specificity of 78.57%, and accuracy of 85.33%.Conclusion: High-frequency color Doppler ultrasound can detect, quantitatively evaluate, and accurately mark the peroneal artery and vein and perforating peroneal artery before fibular myocutaneous flap transplantation.(c) 2022 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.