Ankle-arm index as a screening examination for fibula free tissue transfer

The frequent use of the fibula free flap for mandibular reconstruction has served as an impetus to develop a screening test for this flap. This would detect lower leg vascular disease that could jeopardize the flap or donor e xtremity. Data would allow a decision whether to pursue further lower leg i maging versus consideration of an alternative donor site. The ankle-arm ind ex (AAI) was determined on a prospective series of 62 patients being consid ered for fibula free flap transfer. An AAI of less than 1.0 was found to be predictive of a high rate of lower leg vascular disease (by color flow Dop pler imaging) that would jeopardize the flap or donor extremity. The BAI di d not detect anomalous vasculature of the lower leg (N = 2). If the AAI is less than 1, an alternative donor site to the fibula should be considered, and if it is greater than 1, a color flow Doppler examination of the donor extremity is recommended.