ABSTRACT
This study was initiated to establish a treatment algorithm for preoperative evaluation
of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of
complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated
between 1999 and 2003 in a university-based setting. Reconstructions were completed
using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional
and aesthetic results were determined by completing a thorough patient physical examination
postoperatively. We hypothesized that a routine preoperative angiogram at the donor
site was unnecessary. The Allen's test was the only preoperative evaluation completed
in the 13 patients undergoing the free radial forearm reconstruction. In the remaining
16 patients undergoing free fibula reconstruction, a thorough physical examination
was completed, along with noninvasive Doppler examinations. No angiograms were obtained.
Using this systematic approach, no ischemic complications were observed at the donor
site. Only two complete flap losses were seen, one in each group, due to microvascular
thrombosis. We conclude that preoperative assessment of the donor site(s) with only
an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive
Doppler in the free fibula group appear adequate. Routine preoperative angiogram of
the donor extremity may be unnecessary and place the patient at additional risk for
associated complications.
KEYWORDS
Free-flap - mandibular - angiogram
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