THE CURRENT ROLE OF PREOPERATIVE ARTERIOGRAPHY IN FREE FIBULA FLAPS

The free fibula flap has become a ''workhorse'' flap for reconstructiv e surgeons, yet the indications for preoperative arteriography for the donor extremity remain unclear. Therefore, a retrospective review of all free fibula candidates over a 4-year period was conducted to clari fy the need for preoperative arteriography. One hundred consecutive pa tients were evaluated as potential candidates for free fibula reconstr uction. Twenty-one patients were deemed unsuitable because of associat ed comorbid conditions (15) or unusable limbs (6). The remaining 79 pa tients were candidates for fibula free flap reconstruction. Eight pati ents (10 percent) who had an abnormal lower extremity vascular physica l examination (diminished or absent pedal pulses) underwent arteriogra phy to evaluate the fibula donor site. Free fibula transfer was perfor med in 77 patients (mean age, 41; range, 3 to 80 years) to the followi ng sites: mandible (65), upper limb (4), lower limb (6), and trunk (2) . The overall free flap success rate was 99 percent. Results of arteri ography included: normal three-vessel runoff (6), bilateral peroneal a rteria magna (1), and bilateral posterior tibial artery occlusion with reconstitution via the peroneal artery (1). Two patients with unusabl e fibula donor sites (determination based on arteriographic findings) were reconstructed with ilium and radius. All others underwent uncompl icated free fibula transfer. Ischemic complications at the fibula dono r site did not occur in any patient. This study supports the use of lo wer extremity vascular physical examination as the primary means of ev aluating the fibula donor site. Routine preoperative arteriography is unnecessary and should be reserved for those patients with abnormal va scular examinations.