Mapping of first perforator of thoracodorsal artery using hand-held Doppler and colour Doppler Ultrasound

Abstract

Background: The first perforator of the thoracodorsal artery is the largest and most reliable for the survival of the thoracodorsal artery perforator flap. Given the variation in the position of perforators, a reliable method for the precise identification of the pertinent perforator that would sustain the circulation to the flap would be extremely `valuable.
Methods: This was a comparative cross-sectional study. The Plastic Surgeon used the hand-held Doppler (HHD) to assess for perforator(s) outside the circle 1.5 cm centred on the first perforator point. The procedure was then repeated by a radiologist using the colour Doppler ultrasound (CDU).
The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 20. Statistical significance was determined using a dependent (paired) sample t-test. All tests with a p-value of less than 0.05 were considered significant.
Results: A total of 70 patients were recruited for the study. The age range was 18 to 65 years with a mean of 31.77 years ± 11.72 years. There were 58 males (82.9%) and 12 females (17.1%) with a male-to-female ratio of 4.8:1. Overall, comparing the two ultrasound modalities in mapping perforators outside the first perforator point, HHD = 9.3% and CDU = 10%. The CDU (M = 0.20, SD = 0.40) identified more perforators than HHD (M = 0.19, SD = 0.39) but was not statistically significant t(69) = -1.000, p = 0.32.
Conclusion: Both HHD and CDU showed variations in the location of the first perforator point. The location and suitability of the perforators may be determined with the CDU, while the HHD may then be used for monitor during surgery.