We read the article entitled “Using Duplex Ultrasound for Recipient Vessel Selection” by Hong et al with great interest.[1] They reported that Duplex ultrasound (US) could be a reliable tool for reconstructive surgeons to choose recipient vessels. Since the introduction of new types of flaps such as the perforator-to-perforator flap and superthin flap, detailed evaluation of the vascularity of flap and recipient vessels gets more and more essential and various kinds of US could be applied for preoperative evaluation. US examination is safe for patients, easy to perform, does not take much time, and detects very small vessels with a diameter of 0.5 mm.[2] Moreover, at our hospital Doppler US could also be applied to prevent vascular spasms during rehabilitation after finger or hand replantation. Many hand surgeons kept replanted fingers immobilized for 5 to 7 days after fingers and hand replantation.[3] One of the reasons for this immobilization was that movement of the fingers might cause spasms or thrombosis of anastomotic vessels and lead to necrosis of tissues. However, delayed rehabilitation could cause adhesion of flexor and extensor tendon and joint contractures, and lead to impairment of hand function. Therefore, early mobilization of fingers accompanied with assessments of arterial patency is very important in the field of rehabilitation of finger and hand replantation. To overcome this challenge, we used Doppler US for the assessment of the blood flow of anastomotic vessels during the extension and flexion of joints near the anastomotic area.

This method was performed as follows. The first step was to set the Doppler US on the digital artery distal to the anastomotic area. The second step was to make fingers extend or flex for rehabilitation on postoperative day 1 to 2 while listening to the sound of pulsation of the anastomosed digital artery ([Fig. 1]). If the sound of pulsation diminished or weakened during the extension of the finger, rehabilitation should be stopped because the tension in vessels was too strong to cause spasm. If strong pulsation was continued during the movement of fingers, the blood flow of replanted fingers was reliable so early rehabilitation should be continued to prevent tendons adhesions and joint contractures.