Ankle-arm index as a screening examination for fibula free tissue transfer

The frequent use of the fibula free flap for mandibular reconstruction has served as an impetus to develop a screening test for this flap. This would detect lower leg vascular disease that could jeopardize the flap or donor extremity. Data would allow a decision whether to pursue further lower leg imaging versus consideration of an alternative donor site. The ankle-arm index (AAI) was determined on a prospective series of 62 patients being considered for fibula free flap transfer. An AAI of less than 1.0 was found to be predictive of a high rate of lower leg vascular disease (by color flow Doppler imaging) that would jeopardize the flap or donor extremity. The AAI did not detect anomalous vasculature of the lower leg (N = 2). If the AAI is less than 1, an alternative donor site to the fibula should be considered, and if it is greater than 1, a color flow Doppler examination of the donor extremity is recommended.