The Success of Duplex Ultrasonographic Scanning in the Diagnosis of Extremity Vascular Proximity Trauma

I read with great interest the article by Fry et al 1 in the December 1993 issue of theArchives.The report concerns a cohort of 200 patients with 225 extremity injuries, only 50 of whom underwent confirmatory operative exploration or arteriography. The authors detail remarkably good results with duplex scanning for the diagnosis of significant vascular injury: 100% sensitivity, 97.3% specificity, and an overall accuracy of 98.5%. Although I wholeheartedly agree that duplex scanning may potentially have an invaluable role in the diagnosis of vascular injuries, a few cautionary provisos are in order. In a small pilot study recently published, Schwartz et al 2 found that duplex ultrasonography was capable of diagnosing an arterial injury in 58% of the cases and that it was very technically dependent. This provides a note of caution with regard to the widespread application of duplex scanning. The technical expertise required to adequately examine an