Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap

Despite its many evident merits as a donor site, the principal disadvantage of the anterolateral thigh flap is the variability in its vascular anatomy. Preoperative assessment by Doppler of the vascular perforators has been advocated as routine. We report the accuracy of this method, and describe the strategy for rescue where adequate perforators are not evident. Eighty-six consecutive patients were marked preoperatively using hand-held Doppler and the pattern was compared with intraoperative findings. Assessment by Doppler predicted a median of 3 (range 0-8) perforator signals, and a median of 2 (range 0-5) was found intraoperatively. This overall trend towards false positives was exaggerated in thin thighs, but in the obese there were more false negative results. In 79% of cases explored medially it would have been possible to raise an apparently viable anteromedial thigh flap. As this can be done without extending the incision, it is the option of choice for rescue, although use of more proximal perforators may often be possible.