Color flow-Doppler preoperative assessment in fibula free flap

Background: Fibula free flap was first described by Taylor in 1975, and applied for mandibular reconstruction by Hidalgo in 1989. His pedicle is based on the peroneal artery and itscomitant veins. Vascular alterations may compromise graft and lower limb viability. Congenital anomalies such as peroneal artery abscence or peronealarteria magnaare uncommon. With respect toacquired pathology, it enhances peripheral vascular disease and previous trauma. The best preoperative lower limb assessment is currently controversial. In many clinics clinical examination and arteriography is routine, but Color Flow-Doppler (CFD) and Magnetic resonance angiography arealso used.

Method: A retrospective review of 20 candidates for reconstruction with Fibula flap and preoperative evaluation with CFD between 2011 and 2013.Every test was performed by the same vascular surgeryspecialist. Tibio-peroneal trunk anatomy and viability was evaluated; septocutaneous perforators were marked and surgical correspondence analysed.

Results: CFD successfully imaged cutaneous perforator in all patients. No anatomical variants were diagnosed in any patient. One case was rejected due to monophasic wave and flow alteration. Intraoperative correspondence of the perforator and the CFD location was excellent. No major complications occurred on the donor site.

Conclusion: CFD ultrasonography is effective to evaluate the viability of the lower limb before fibula flap harvesting. It monitorsthe Tibio-peroneal trunkin enough detail, excluding anatomical variants and peripheral vascular disease. Reliable marking of septocutaneous perforators and pedicle length provides a better reconstruction design. Key words: fibula free flap; colour flow-Doppler; perforators

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Color flow-Doppler preoperative assessment in fibula free flap
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