Abstract
Objective: Determine whether Doppler ultrasound (DUS) is a necessary preoperative test for all patients undergoing radial forearm free flaps (RFFF) or if it can safely be omitted in patients with a normal clinical Allen test (CAT).
Method: Retrospective analysis of 143 consecutive patients who underwent RFFF at Vanderbilt University Medical Center between 1992 and 2006. Charts were reviewed for the Allen test, Doppler ultrasound, intraoperative vascular findings, and clinical outcomes. Data were recorded in a Redcap Database and statistical analysis performed by the Vanderbilt Department of Biostatistics.
Results: Ninety percent of DUS and 92% of CAT were normal. The relationship between DUS and CAT was statistically significant. For patients with sufficient flow on CAT, 98% were in agreement with the SAT. Of the 3 patients with insufficient flow intraoperatively, 2 had documented normal CAT and DUS. Two patients developed hand ischemia. Both had normal CAT and no preoperative DUS. One hundred percent of abnormal DUS were abnormal by CAT.
Conclusion: Postoperative RFFF hand ischemia is an extremely rare condition, but it does cause significant postoperative morbidity. DUS testing highly correlates with the findings of CAT and does not appear to be superior in predicting intraoperative findings or postoperative complications. DUS should be limited to patients who have an abnormal CAT.
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