Refining Surgical Precision: The Impact of Color Doppler Ultrasound-Guided Perforator Mapping on Anterolateral Thigh Flap for Oncologic Patients

Abstract

Background

This study investigates the impact of preoperative ultrasound mapping using color Doppler ultrasound (CDU) on surgical outcomes for anterolateral thigh (ALT) free flap reconstructions.

Methods

A retrospective review was conducted on patients who were diagnosed with cancer and underwent ALT free flap reconstruction. Patients were grouped based on the use of either computed tomography angiography (CTA) with a handheld Doppler (HHD) or CDU for preoperative planning. Patient demographics, operation times, flap elevation durations, and postoperative outcomes were evaluated.

Results

A total of 63 patients were included in this study (23 in the CTA + HHD group and 40 in the CDU group). Preoperative CDU planning was associated with a significantly shorter total operation time (214 vs. 252 minutes, p = 0.05) compared with conventional imaging. The CDU group also demonstrated significantly lower rates of revision surgery (p = 0.006), total flap loss (p = 0.05), and partial flap loss (p = 0.05). In multivariate linear regression analysis, CDU use was the only factor independently associated with shorter flap elevation time (p = 0.04) among the evaluated surgical variables.

Conclusion

The findings suggest that incorporating preoperative ultrasound mapping enhances surgical outcomes by optimizing flap elevation and reducing complications. The use of CDU proves valuable in achieving better preoperative planning, leading to improved efficiency and overall success in reconstructive surgeries using ALT free flaps.

Keywords

ultrasound - free flap - cancer

Publication History

Received: 07 April 2025

Accepted: 19 November 2025

Article published online:
08 December 2025

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