Wound reconstruction using skin flaps instead of skin grafts is becoming more common. Skin flaps are versatile and can be used to cover large tissue defects. Improvements in surgical perforator flap knowledge has allowed for more complex wound reconstruction. A successful perforator flap requires a dominant perforator to allow for revascularization and wound healing because the skin flap does not depend on the vascularity of the target surgical site. The location of the perforators for these flaps is usually done with hand-held Doppler in the operating room or by preoperative CT angiography. The vascular lab is not often called to assist in locating the blood supply for these procedures.
This report focuses on two patients who needed extensive pelvic area reconstruction. The first patient required this for rectal cancer, and the second for vulvar cancer. The vascular lab was asked to identify potential perforators with duplex ultrasound in anticipation of performing complex surgical oncological wound reconstruction.
The exams involved identification of the aorta, inflow vessels, and perforators using b-mode ultrasound, color, and spectral Doppler evaluation. Diagrams were provided to the surgeons as a part of the report. Both surgeries were successful in using reconstruction flaps.
Using the vascular lab staff to identify and mark these dominant perforators allows surgeons to be confident the flaps that the surgeon has selected have the necessary vasculature for successful wound closure. In addition, it also saves valuable operative time for surgeons who may have to spend significant time in finding the perforators and they may not know about the size of the vessels based on Doppler alone. There is also significant cost savings and avoidance of radiation and dye exposure when compared to using CT angiography.
Leslie Wormely, Lead Vascular Sonographer, The Christ Hospital