SELECTIVE USE OF PREOPERATIVE LOWER-EXTREMITY ARTERIOGRAPHY IN FREE-FLAP RECONSTRUCTION

Preoperative angiography is commonly utilized prior to free flap recon struction of the lower extremity. The charts and radiographs of 38 pat ients who underwent free flap reconstruction, after acute posttraumati c lower extremity injuries, were studied. Patients were categorized ac cording to the presence or absence of vascular abnormality based on pu lse examination alone. Specific vascular abnormalities were recorded i n each group. Of the 38 patients who had preoperative lower extremity arteriography, 23 were found to have normal dorsalis pedis and posteri or tibial pulses. Only 1 of these patients had an angiographic abnorma lity. Of the 15 patients with abnormal pulse examinations, all were fo und to have angiographic abnormalities. Cost analysis of the lower ext remity angiogram revealed a total additional expense of $2,957. Pulse examination was found to be a sensitive and effective predictor of low er extremity vascular integrity. Although lower extremity angiography is encouraged when distal pulse examination is abnormal, the use of pr eoperative arteriography for lower extremity microvascular free flap r econstruction is probably unnecessary in most patients with normal dis tal pulses.