Objective: To investigate the application value of Doppler ultrasound hemodynamic parameters in evaluating the survival of perforator flaps. Methods: 80 patients who underwent perforator flap transplantation from January 2022 to January 2025 were selected. Postoperatively, color Doppler ultrasound was used to examine the flap"s blood flow. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the perforator vessels within the flap were measured, and flap survival was observed. Results: A total of 72 flaps survived and 8 flaps became necrotic. The PSV and EDV values of the surviving flaps were higher than those of the necrotic flaps, while the PI value was lower, with all differences being statistically significant (P<0.05). There was no significant difference in RI between the groups (P>0.05). In surviving flaps, PSV and EDV values gradually increased, and PI values gradually decreased on postoperative days 1, 3, 5, and 7, with statistical significance (P<0.05). PSV, EDV, and PI showed predictive value for flap necrosis, with Areas Under the Curve (AUC) of 0.823, 0.795, and 0.801, respectively. The combined AUC of PSV, EDV, and PI was 0.896, with a sensitivity of 87.5% and a specificity of 88.9%. Conclusion: Doppler ultrasound can quantitatively assess the hemodynamic status of perforator flaps. Its measured parameters, such as PSV, EDV, and PI, have significant predictive value for flap survival, providing an objective basis for early clinical intervention.