Introduction: Awaiting tissue engineering evolution, fibular free flap keeps the most frequently indications to repair large osteocutaneous resections especially mandible and maxilla defects. DSA stayed the gold standard during long time, recently many teams studied MRA in preoperative evaluation to assess anatomy of peroneal, anterior and posterior tibial vessels. MRA is seems to become the new reference because of the non invasive nature and equivalence compared with DSA.

Patients and methods: From January 2006 to January 2011 we reviewed retrospectively all patients with a osteocutaneous defect needing FFF reconstruction. We performed a monocentric and retrospective study including 119 patients who underwent preoperative MRA we retrospectively studied the indications changes or confirmation by preoperative MRA Results: In 101 cases the first indication was confirmed .In 18 cases indication was changed (opposite side harvesting, other flap or no free flap reconstruction) because of MRA results. Five times the side of harvesting was changed because of a better other side 10 patients underwent a scapula because anomalies were bilateral and jeopardized Flap and/or leg vitality. We had only 4 flaps losses (3,5%). MRA is a good imaging to plan FFF harvesting, we saw tibio-peroneal trunk anatomy as well as a DSA (atherosclerotic disease, anatomic variants) and in more than 90% of the cases we could see perforators and plan the skin paddle. MRA is not invasive, radiation-free and less expensive than DSA.Although DSA has a better space-resolution, MRA is sufficient. For us DSA is no more justifiable in FFF harvesting.