COLOR DUPLEX IMAGING FOR IDENTIFYING PERFORATORS PRIOR TO PRETRANSFER EXPANSION OF FASCIOCUTANEOUS FREE FLAPS

Pretransfer expansion of a fasciocutaneous free flap simultaneously creates a flap of large dimensions and allows primary closure to minimize donor site deformity. Although simple in concept, initial placement of the expander envelope must be done to ensure that the ultimate vascular integrity of the flap has not been compromised. This approach necessitates a precise knowledge of the dominant perforator to the flap and its location. Unfortunately, the perforators nourishing fasciocutaneous flaps are notorious for their variability. As a means to circumvent this potential obstacle, preoperative color duplex imaging was performed in 4 patients, who then underwent pre-expansion of a fasciocutaneous free flap. All perforators within the chosen donor flap territory were identified and measured to ascertain dominance. Preoperative mapping delineated safe regions that could be undermined for expander placement. At the time of ultimate free flap elevation, in vivo dissection of all perforators proved their caliber to be as predicted. No perforators had been violated by the expansion process. Concomitant linear closure of all donor sites after flap transfer obviated any need for skin grafts.