The ability to freely transfer tissue to an area with heterotopic circulation has continued to grow. The ability to monitor buried free flaps continues to be a challenge, especially in head and neck reconstruction. The unrecognized failure of a buried free flap to the head and neck is not only devastating, but also may be associated with life-threatening complications. We present a regimen for the effective, noninvasive monitoring of the high-risk buried free flap with the use of high-resolution, color, twophase duplex sonography. Eleven consecutive patients underwent head and neck free tissue transfer to a buried location. All patients were studied 24 to 36 hours after surgery, using the ATL 3000/M9 color-duplex ultrasound machine. All patients received invasive confirmation with direct visualization (endoscopic). Correlation between sonographic and direct clinical evaluation results was 100 percent. Patent arterial and venous anastomoses were demonstrated in all studies. High-resolution, color, two-phase duplex sonography provides an effective, noninvasive method to directly visualize the free flap blood supply at the pedicle. Duplex sonography can be used as an effective means to evaluate perfusion in a buried head and neck free flap.
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