Quantitative Preoperative Peroneal Vessel Assessment in Fibula Free Flap Surgery

Area of Science:

• Vascular Surgery
• Radiology
• Biomedical Engineering

Background:

• Fibula free flap (FFF) surgery complications are often linked to donor peroneal artery vascular disease.
• Current preoperative evaluation relies on qualitative Computed Tomography Angiography (CTA) assessments, limiting risk stratification.

Purpose of the Study:

• To implement and evaluate quantitative scoring systems (Bollinger score and Lower Limb Arterial Calcification Score - LLACS) for improved preoperative risk assessment in FFF surgery.
• To assess the distinct vascular health components quantified by Bollinger score (stenosis) and LLACS (arteriosclerosis).

Main Methods:

• Retrospective review of 117 head and neck FFF procedures.
• Calculation of peroneal artery Bollinger scores and crural segment LLACS from preoperative CTAs.
• Analysis of the association between scores and 90-day postoperative complications.

Main Results:

• Higher Bollinger scores significantly correlated with increased complication risk and longer hospital stays.
• Combining Bollinger and LLACS scores enhanced risk stratification.
• High-risk patients identified by combined scores had an 8.36-fold higher risk of complications.

Conclusions:

• Quantitative preoperative assessment of peroneal vessels using Bollinger and LLACS improves risk stratification for FFF surgery.
• These scoring systems can aid in patient selection and guide strategies to minimize postoperative complications.
• Integrating multiple quantitative scoring systems offers a comprehensive vascular health assessment.