Clinical Applications Of Doppler Ultrasound In Distal Sural Fasciocutaneous Flap Operation

Objective:study and evaluation of the use of doppler ultrasound in distal Sural fasciocutaneous flap operation.Methods:1.Retrospective analysis of our department distal Sural fasciocutaneous flap operations,48 cases,from January 2002 to April 2007.2. Using HUNTLEIGH MINI DOPPLEX D900 portable vascular ultrasound and LOGIQ-9 Color Doppler ultrasound instruments to check number and level of pedicle perforator vessels,evaluation of small saphenous vein depth,location and blood spectrum in normal 40 legs.3.Anatomical observation of perforating branch of peroneal artery and small saphenous vein in seven amputated leg specimens with preoperative ultrasonic examination of two osteosarcoma cases.Results:Among 48 skin flap cases reviewed 13 cases(30%)showed complications related to vascular insufficiency.Ultrasonic examinations of vascular pedicle in legs of 40 normal persons.Number of perforators anterior to the axis of the pedicle was 2-5 branches and run with the past anatomical findings.The level of lowest perforator found to be 3.17±0.99cm with use of HUNTLEIGH MINI DOPPLEX D900 and 3.99±1.06cmwith use of LOGIQ-9.the latter results are more convincing Distance of Small saphenous vein in pedicle from the surface was 0.32cm±0.10cm.In 32 cases(80%)small saphenous vein were very slow,undetectable blood spectrum,In 8 cases(20%) small saphenous vein flow was faster and blood spectrum can be detected.If the great saphenous vein injury it will lead to increase in the flow at the small saphenous vein but the deep veins and communicating veins can not fully compensate.Anatomy revealed that the axial anterior vascular perforator in pedicle is the main nutrient vessel of the flap.The small saphenous vein is more superficial than sural nerve in the middle and the lower part of pedicle. Anatomical study of 2 amputated specimens showed that ultrasound can estimate the pedicle vascular perforator number truly.The location and level of vascular perforators from the surface are slightly more superficial and lower than the actual location.Conclusion:1 Vascular pedicle and skin flap necrosis shows a close relation.2.Perforator vessels number and level position shows an individual variety.Ultrasound examination is advised when flap is expanded or lower flap rotation point is less than 5cm.3.In most normal persons foot venous return, small saphenous vein are very slow.When flap rotation point is higher or flap area is not large,no need for ligation of pedicle of the small saphenous vein. During ultrasonic check of spectrum and blood flow of pedicle of small saphenous vein,ligation is advised.4.After ultrasonic location of perforators and small saphenous vein using a small incision to ligate the small saphenous vein in the middle and lower parts and a little posterior to pedicle axis.It is a simple approach with no risk of perforator artery injury.5.The use of color doppler ultrasound.in distal Sural fasciocutaneous flap operation found to be of high clincal value.