A Prospective Head-to-Head Comparison of Color Doppler Ultrasound and Computed Tomographic Angiography in the Preoperative Planning of Lower Extremity Perforator Flaps

Background: This investigation compared the application of color Doppler ultrasound and computed tomographic angiography in preoperative planning of lower extremity perforator flaps. Method: This study was a prospective comparative analysis of 40 patients with lower extremity defects who underwent reconstruction with perforator flaps. The position, caliber, route, and quality of the perforator vessels were detected by computed tomographic angiography and color Doppler ultrasound preoperatively. The results of the preoperative navigation with both imaging techniques were verified during the operation. Results: Color Doppler ultrasound had a higher accuracy in terms of identifying (95 percent versus 90 percent) and locating (95 percent versus 82.5 percent) the perforators in the lower extremity. Color Doppler ultrasound required approximately 25 minutes for examination, whereas computed tomographic angiography required 46 seconds for the scan and approximately 22 minutes for the image analysis. There was no significant difference between the two methods. Conclusions: Preoperative radiologic vessel navigation is capable of offering valuable information such as the perforator's location, diameter, and path; and information regarding the quality of the perforators, which can shorten the operative time and improve the surgical results. The authors recommend color Doppler ultrasound for preoperative planning when harvesting perforator flaps from the lower extremity. In cases where the patient has a metal implant, allergy to the contrast agent, or renal insufficiency, color Doppler ultrasound is the only option. In time, the use of color Doppler ultrasound and computed tomographic angiography in combination will be recommended to improve the accuracy of preoperative perforator navigation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.