USE OF COLOR DOPPLER FLOW IMAGING FOR PREOPERATIVE ASSESSMENT IN FIBULAR OSTEOSEPTOCUTANEOUS FREE TISSUE TRANSFER

Fibular osteocutaneous free tissue transfer represents state-of-the-ar t reconstruction of the oromandibular complex after oncologic resectio n. Because the blood supply of the fibular flap is based on the perone al artery and venae comitantes, if is essential to determine preoperat ively whether adequate perfusion to the donor extremity will persist a fter sacrifice of the peroneal pedicle. Vascular variations or periphe ral arterial occlusive disease may exist whereby sacrifice of peroneal vessels can cause ischemia of the lower leg and foot. Therefore, angi ography of the lower extremity and magnetic resonance angiography have been advocated to determine the arterial supply to the lower leg, Tho ugh accurate, these examinations carry risk for morbidity, and both ar e expensive. Color Doppler flow imaging is a noninvasive ultrasound ex amination used to measure antegrade and retrograde blood flow, We pros pectively evaluated color Doppler flow imaging as a means of preoperat ive evaluation of the lower extremity for candidates for fibular flaps . Ability to image peroneal vessels and to determine collateral and di stal perfusion were evaluated, The patients were compared with a contr ol group of patients with peripheral arterial occlusive disease, Color Doppler flow imaging provided accurate hemodynamic information for al l patients and allowed successful fibular transfer far all patients wh o received free flaps, The modality is comparable in accuracy with the angiography of the lower extremity and magnetic resonance angiography and has the advantages of low cost and no morbidity.