Reliability of handheld Doppler in planning local perforator-based flaps for extremities

The perforator-based flap is one of the most common and frequently used options for soft tissue reconstruction on extremities to remedy small to medium-size defects. A Doppler probe has been used to identify these perforators for the designing of the flap base, axis and dimensions. The reliability of the handheld Doppler was assessed for its sensitivity and positive predictive values.

A prospective study on upper and lower extremities was designed, and 14 volunteers were selected for the study. A handheld Doppler with 8- and 10-MHz probes was used, and the volunteers were subsequently scanned using a color duplex with a linear-array probe of 7 and 10 MHz. A total of 94 perforators were identified on the back of the hand, wrist, and distal 24 cm of the leg.

The 49 perforators marked on 10 legs produced 40 correct, 3 false-positive, and 6 false-negative results. The 33 distal intermetacarpal perforators marked on the back of 11 hands yielded 26 correct, 5 false-positive, and 2 false-negative results. The 12 dorsal carpal arch perforators marked gave 6 correct and 6 false-positive results.

Unidirectional flowmetry using a handheld Doppler is a practical and reliable method for identifying skin perforators. It can be used to plan and design a flap for soft tissue defect reconstruction of extremities in selected cases. The reliability of its use is size dependent, and vessels with a smaller diameter showed unacceptably high false-positive results.