Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 34:
Arteriogram and Doppler Preoperative Evaluation for Free Tissue Transfer
  In reconstructive microsurgery, the Doppler is most helpful in tracing the arterial pulse of a donor or recipient vessel. At the donor site, the Doppler can help outline the artery of the pedicle to be transferred so that the skin paddle can be more precisely centered over the nutrient vessel. To determine the best location for skin incisions at the recipient site, the Doppler helps trace the relationship of this vessel to the skin. The Doppler does not, however, give any information about the depth of the vessel in relation to the skin, nor does it describe the vessel quality or caliber. For these reasons, the preoperative arteriogram is more helpful, especially in the recipient area. In donor flaps, however, where vascular anatomy is predictable, the Doppler may be the only preoperative evaluation necessary. The Doppler may also be the only preoperative modality necessary in the evaluation of recipient sites of healthy, nontraumatized, nonradiated patients, which unfortunately is rare.


In general, the donor site is taken from an uninjured area and does not involve essential vessels. If the potential donor area has received a significant injury or radiation, or if the vessels in the donor area vary widely in their origins and distributions, either a preoperative arteriogram or Doppler, or both, are essential for planning the free tissue transfer.


Temporoparietal Fascia. With or without scalp, this is a reliable fascial or fasciocutaneous flap supplied by the superficial temporal artery and vein. This vessel can be easily found with a Doppler and is often palpable. The bifurcation of the superficial temporal artery and other more distal branches can be located and traced on the skin surface with Doppler, making it easier to design a reliable skin paddle. An arteriogram is rarely indicated unless there is a suspicion of vascular anomaly detected either from the history or by Doppler examination, such as radiation trauma, peripheral vascular disease, or diabetes. Abnormal vascular supply to the temporoparietal fascia is rare.

Scapular Flap. With or without the lateral border of the scapula, this flap has a predictable vascular supply based on the subscapular artery. The Doppler is helpful in identifying the location of the nutrient vessel as it comes through the triangular space to supply the skin on the back. This information is useful in designing the skin paddle. An arteriogram is rarely indicated in this flap.

Latissimus Dorsi and Serratus Muscle or Musculocutaneous Flaps. Both of these flaps are reliable and have predictable vascular anatomy. Neither Doppler nor arteriogram is indicated.

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