[Donor site digital subtraction angiography before mandible reconstruction with free fibula transplantation]

The use of fibula free flap has become established as a reliable and popular method for reconstruction of segmental mandibular defects. Vascular anomalies of the donor site may compromise the blood supply of the flap, may jeopardize perfusion of the foot or cause technical difficulties during the procedure. Clinical examination of the circulation in the lower extremities may have relatively normal results. Preoperative vascular imaging detects aberrant cases and thus may contraindicate the use of fibula free flap or may alter the surgical plan. Authors performed 64 preoperative lower-limb digital subtraction angiographies (DSA) in a series of 39 consecutive patients clinically judged to be satisfactory candidates for free fibula transfer. DSA detected vascular anomalies in 10 extremities (15.6%). Regarding the high potential for significant donor site morbidity authors consider vascular imaging essential part of preoperative evaluation.