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Preoperative Angiography for Free Fibula Flap Harvest: A Case Series
Noor Alolabi1,2, Haley Augustine2, Forough Farrokhyar3
1Division of Plastic Surgery, Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada.
Plastic Surgery (Oakville, Ont.)
|May 16, 2022
Summary
Routine preoperative angiography is crucial for free fibula flap (FFF) surgery, as physical exams alone cannot reliably detect vascular issues. This imaging ensures flap success and patient safety by identifying abnormalities before surgery.
Area of Science:
- Vascular Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Free fibula flap (FFF) is a common reconstructive technique.
- Preoperative assessment of lower extremity vasculature is critical for FFF success.
- The role of routine preoperative angiography in FFF planning requires clarification.
Purpose of the Study:
- To evaluate the necessity of preoperative lower extremity angiography for FFF.
- To determine if angiography alters operative planning.
- To assess the accuracy of physical examination in identifying vascular abnormalities.
Main Methods:
- Retrospective case series of 70 patients undergoing FFF reconstruction.
- Analysis of preoperative physical examinations and lower extremity angiograms (aortic angiogram runoff or CT angiography).
- Evaluation of changes in operative plan and perioperative complications.
Main Results:
- Angiography altered the operative plan in 12.9% of cases, often when physical examination was normal.
- Physical examination had low sensitivity (22.2%) for detecting aberrant vascular anatomy.
- No limb ischemia complications occurred; physical exam findings sometimes incorrectly precluded FFF use.
Conclusions:
- Routine preoperative angiography is essential for safe and successful FFF procedures.
- Physical examination alone is inadequate for detecting vascular abnormalities that could compromise the flap or limb.
- Angiography ensures optimal surgical planning and patient outcomes in FFF reconstruction.
