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Updated: Jun 24, 2026

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Asymptomatic lower extremity deep venous thrombosis resulting in fibula free flap failure
Adam S Jacobson1, Azita S Khorsandi, Daniel Buchbinder
1Department of Otolaryngology-Head and Neck Surgery, Institute for Head, Neck, and Thyroid Cancer, Beth Israel Medical Center, New York, New York, USA. ajacobson@chpnet.org
Objectives/Hypothesis:
The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease.
Methods:
Retrospective chart review.
Results:
Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps.
Conclusions:
This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009.
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