Donor site evaluation for fibula free flap transfer.

PURPOSE: The role of routine preoperative angiography in patients undergoing fibula flap transfer remains controversial. A recent survey of experienced microvascular surgeons indicated that routine angiography may be unnecessary in patients with no symptoms of peripheral vascular disease and normal lower extremity pulses. To study the necessity of performing preoperative vascular imaging studies, the incidence of congenital and acquired vascular anomalies that prevented the harvest of a fibula flap is reported in a series of patients undergoing evaluation for oromandibular reconstruction

PATIENTS AND METHODS: A series of 19 consecutive patients who underwent preoperative lower extremity vascular imaging studies in anticipation of performing a fibula free flap is presented.

RESULTS: Angiographic findings significantly altered the surgical reconstruction that was performed in 4 of 19 (21%) patients. Three patients with a history or examination suggestive of peripheral vascular disease were excluded on the basis of the findings at the time of radiographic study. In a fourth patient, the contralateral leg was used for reconstruction when preoperative angiography showed a dominant peroneal artery supplying the foot in the extremity initially considered for flap harvest.

CONCLUSION: History and physical examination are not helpful in detecting most congenital vascular anomalies that would place the foot at risk for ischemia if the peroneal artery is sacrificed. The findings of this small series are consistent with the previously documented incidence of anomalous blood supply to the foot and demonstrate the need for preoperative vascular imaging studies in patients undergoing fibula free flap transfer to avoid a potentially catastrophic complication.