ABSTRACT
Among arterial anatomic conditions which will adversely affect the harvest of the
fibula are 1) significant arteriosclerotic disease within the tibial-peroneal vessels;
2) peroneal arteria magna (PAM), a condition in which only the peroneal artery supplies
the foot; and 3) absence of the peroneal artery, either congenitally or as an acquired
defect. In each of these anatomic conditions, removal of the peroneal vessels and
the fibula free flap will jeopardize either the donor leg, the fibula flap, or both.
All patients considered for fibula flaps were evaluated with preoperative leg angiograms.
In 28 consecutive patients evaluated with angiography for planned free-fibula flap
reconstructions, 23 actually underwent free-fibula harvest. Angiographic abnormalities
that altered the operative plan were found in seven (25 percent) patients. Four of
the seven patients had vascular examinations prior to surgery with abnormal findings.
Three of the seven (11 percent) patients with abnormal arterial anatomy had normal vascular examinations prior to surgery. Thus, if a preoperative angiogram had not
routinely been done, the abnormal anatomy would not have been discovered until surgery.
This could have resulted in an unusable flap in one patient, and an ischemic or gangrenous
foot in two other patients.
With this angiographic guidance, there were no vascular complications from harvest
of the fibula. The routine use of preoperative bilateral leg angiography is recommended,
or an alternative method of vessel imaging, in all patients evaluated for microvascular
free-tissue transfer of the fibula.
