Attributes and shortcomings of acoustic Doppler sonography in identifying perforators for flaps from the lower extremity.

The preoperative identification of perforators can facilitate the appropriate design of perforator flaps from the lower extremity. Although computed tomographic arteriography can now be considered the gold standard in this regard, this technology is not universally available or inexpensive, with a nonnegligible risk from radiation exposure. An old standby, the ubiquitous acoustic Doppler sonography, still has a role as an alternative, despite perhaps its too high sensitivity and low specificity. Regardless of the modality employed, the efficacious harvest of a perforator flap will still require constant vigilance during its dissection due to anatomic anomalies of the course of these perforators, which is the expected norm.