Background: The flap selection criteria in lower extremity reconstruction are based on the wound characteristics and donor site morbidity. We hypothesized that the decision-making could be influenced by integrating Duplex Ultrasound (DU) in the preoperative design.
Methods: We retrospectively reviewed data on patients who underwent lower-extremity microvascular soft-tissue reconstruction at our institution by the same surgeon. In Group A, DU was integrated in the preoperative design of the microsurgical reconstruction, whilst in Group B the choice of free flap donor site and level of anastomosis were based on clinical criteria only.
Results: A total of 48 microvascular reconstructions were recorded. DU was used preoperatively in 20-patients, whilst in 28-patients flap selection was based on clinical criteria. There was a significant decrease in perforator flap (45% over 64%) and a significant increase in muscle flap preference (55% over 32%) in the DU-group. There was no significant difference (10% over 11%) in the donor site selection with considerable morbidity. There was no flap failure in the DU-group, whilst 3 flaps failed in the second-group (p< 0.05, χ(2)-test). Wound healing was significantly faster in the DU-group (21±3 days) compared to 37±3 days in the other group (p< 0.05, t-test).
Conclusion: Preoperative ultrasound studies moved flap preference towards chimeric and muscle flaps with low morbidity to match the three-dimensional defect and to promote healing.
Keywords: lower limb reconstruction; free flap; donor site; duplex ultrasound.