Preoperative identification of perforating vessels to the skin by color duplex imaging

Recent improvements in high-frequency linear array transducers with color duplex imaging permit the precise identification and estimation of the caliber of minute perforating vessels to the skin as small as 0.5 mm. An obvious corollary role would be the accurate preoperative delineation of the vascular anatomy of a skin flap, which could be essential to ensure its viability. This technology was then applied to map the blood supply to skin flaps in eight patients, which was subsequently verified at the time of their actual surgical dissection. Because anomalies of the skin circulation are not uncommon, this extended capability for color duplex imaging can facilitate a more optimal design of skin flaps to better ensure their chance for survival by the inclusion of appropriate nutritive blood vessels.