The value of color duplex imaging for planning and performing a free anterolateral thigh perforator flap

The free anterolateral thigh (ALT) flap has been used successfully for various soft tissue reconstructions. However, the drawback of this flap has been the difficulty associated with finding consistent perforators due to the variable anatomy. In this study, the value of color duplex imaging for reliably identifying the perforators of the flap was investigated.

Nineteen patients of various ethnicities and sex (17 men, 2 women) were studied and were planned to undergo reconstruction with free ALT flaps. They were evaluated using color duplex in the operating room before flap elevation. This imaging was performed in less than 20 minutes by a vascular technologist under the guidance of the surgeon on both thigh donor sites.

All imaged major perforators were identified during flap elevation (sensitivity, 100%) and all the flaps were successfully elevated based on 1 or 2 identified perforators. There were no unexpected operative plan changes. The perforators were mapped, allowing for easy dissection secondary to the ability to evaluate the perforators for their size and location as well as potential intramuscular course. Also, the surgeons were able to select the side that was likely to give the highest probability of success.

The color duplex scan is a useful imaging modality for planning and performing free ALT flap. It enables surgeons to improve efficiency in the operating room and overall outcomes, as well as shortens the learning curve when first performing these highly variable flaps. The close working relationship between the vascular technologist and the surgeon may be the key to its success.