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J Reconstr Microsurg
DOI: 10.1055/a-2803-4759
Original Article

Color Doppler vs. Hand-Held Doppler: Which Is More Accurate for Preoperative Mapping of osteocutaneous Fibula Free-Flap Perforators?

Authors

  • Dominik Andrzej Walczak 

    1   1st Department of Oncological Surgery, subunit for Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)

  • Jakub Opyrchał

    2   2nd Department of Oncological Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)

  • Agata Żółtaszek

    3   Faculty of Economics and Sociology, University of Lodz, Lodz, Poland (Ringgold ID: RIN49602)

  • Ewa Migacz

    4   Department of Otorhinolaryngology, Medical University of Warsaw Department of Dentistry, Warszawa, Poland (Ringgold ID: RIN317618)

  • Łukasz Krakowczyk

    1   1st Department of Oncological Surgery, subunit for Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)

  • Giuseppe Visconti

    5   Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Rome, Italy

  • Adam Maciejewski

    1   1st Department of Oncological Surgery, subunit for Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)

  • Cezary Juliusz Szymczyk

    1   1st Department of Oncological Surgery, subunit for Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)

  • Daniel Marek Bula 

    1   1st Department of Oncological Surgery, subunit for Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland (Ringgold ID: RIN49598)
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Background: Accurate preoperative mapping of skin‐paddle perforators is vital for osteocutaneous fibula free flap (FFF) success. While hand‐held Doppler (HHD) is widely used for its convenience, its performance compared to color Doppler ultrasound (CDU) in FFF planning remains uncertain. Methods: In this prospective study, 50 consecutive patients undergoing fibula free flap reconstruction after head and neck cancer resection were evaluated. Each patient underwent HHD and CDU mapping on the day before surgery. Perforator skin‐surface location, anatomical type (septocutaneous vs. musculoseptocutaneous), peak systolic velocity, and source vessel (peroneal vs. posterior tibial) were recorded. Mapping marks were concealed between examinations. Results: A total of 185 perforators were confirmed intraoperatively (mean 3.7 per limb). CDU identified 179 candidates, yielding 95% sensitivity, 92% specificity, and 94% accuracy. HHD detected 155 sites, achieving 59% sensitivity, 6% specificity, and 48% accuracy, with significantly more false positives and negatives (p < 0.001). Both overall and dominant perforators clustered in the fourth decile of the lower leg (counting from lateral malleolus to fibular head). Distal regions were dominated by septocutaneous vessels, while musculoseptocutaneous types were more common in proximal regions. Anatomical variants—perforators draining into posterior tibial instead of peroneal vessels—occurred in 8% of cases and were identified exclusively by CDU. Conclusions: CDU outperforms HHD for preoperative perforator mapping in osteocutaneous FFF, combining high spatial precision with reliable hemodynamic assessment and variant detection. Incorporation of CDU into routine surgical planning promises to enhance flap design accuracy and minimize intraoperative uncertainty.



Publication History

Received: 15 September 2025

Accepted after revision: 13 January 2026

Accepted Manuscript online:
18 February 2026

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