PREOPERATIVE COLOR-FLOW DOPPLER IMAGING FOR FIBULA FREE TISSUE TRANSFERS

Fibula osteocutaneous free tissue transfer to reconstruct the oromandi bular complex is a widely recommended technique following oncologic re section. Preoperative determination of adequate perfusion to the donor extremity is necessary to assure lower extremity viability after flap harvest. Vascular variations and/or peripheral arterial occlusive dis ease (PAOD) may exist whereby sacrifice of peroneal vessels can cause ischemia to the lower leg and foot. Additionally, variability of cutan eous perforators can make the fibula skin paddle viability unpredictab le. Color flow Doppler (CFD) is a reliable modality to preoperatively assess the lower extremity in fibula osteocutaneous free tissue transf er patients. Prospective CFD examination of 38 consecutive patients (7 6 legs) considered for fibula free flap reconstruction was performed. A standard protocol was designed to evaluate the lower extremity vascu lature and identify cutaneous perforators with CFD. Findings were stud ied with respect to flap choice, operative findings, and reconstructio n outcomes. Number of cutaneous perforators and their impact on skin p addle design were also recorded. Color flow Doppler's ability to image peroneal vessels as well as determine collateral and distal perfusion were effective. CFD accurately identified bilateral vascular anomalie s in one patient (2.6%), and significant arterial disease in three pat ients (7.9%). Cutaneous perforators were also accurately mapped and co nfirmed intraoperatively in 31 patients. In several instances, the inf ormation provided by the CFD examination altered flap selection, 4/38 patients (10.5%), or skin paddle design, 5/32 patients (15.6%). Color flow Doppler allowed successful fibula transfer in all the free flap c andidates with normal exams. It has the advantages of low cost and no morbidity. CFD allows for accurate mapping of fibula cutaneous perfora tors which facilitates skin paddle design. We recommended the use of p reoperative CFD in all patients being considered for fibular free flap surgery.