J Reconstr Microsurg 2011; 27(3): 169-172
DOI: 10.1055/s-0030-1270531
© Thieme Medical Publishers

Fibular Free Flap with Arteria Peronea Magna: The Role of Preoperative Balloon Occlusion

Benjamin B. Rahmel1 , Thomas M. Snow3 , Martin D. Batstone1 , 2 , 3
  • 1Oral and Maxillofacial Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
  • 2University of Queensland, Brisbane, Australia
  • 3Department of Radiology, Gold Coast Hospital, Gold Coast, Australia
Further Information

Publication History

Publication Date:
18 January 2011 (online)


The free fibular osteocutaneous flap is a commonly used donor for reconstruction of mandibular defects. Vascular abnormalities and leg trauma are relative contraindications to the use of a fibular free flap. Peroneal arteria magna (PAM) is one such vascular abnormality that may preclude the use of the graft due to the high risk of lower-limb ischemia. Lower-limb angiography is the standard for assessing the lower-limb vascular anatomy; however, the indications remain controversial. Although balloon occlusion has been used to assess the vascular supply in distal bypass surgery, there have no reported cases of balloon occlusion to assess the viability of the distal extremity with PAM. Intraoperative assessment of vascular anatomy with an aborted harvest can lead to significant morbidity and cost. Balloon occlusion provides a relatively safe and minimally invasive technique for assessment of potential lower-limb ischemia in patients with PAM.


Benjamin B Rahmel, M.D. 

c/o Oral and Maxillofacial Unit, Royal Brisbane and Women's Hospital

Herston, Queensland, Australia 4029

Email: b.rahmel@bigpond.net.au