The Role of Donor Site Angiography before Mandibular Reconstruction Utilizing Free Flap

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

REFERENCES

• 1 Taylor G I, Miller G DH, Ham F J. The free vascularized bone graft: a clinical extension of micro-vascular techniques.  Plast Reconstr Surg. 1975;  55 533-544
• 2 Foster R D, Anthony J P, Singer M I et al.. Microsurgical reconstruction of the midface.  Arch Surg. 1996;  131 960-965 discussion 965-966
• 3 Yang G, Gao Y, Lin X et al.. Forearm free skin transplantation.  Natl Med J China. 1981;  61 139-141
• 4 Kerawala C J, Martin I C. Palmar arch backflow radial forearm free flap harvest.  Br J Oral Maxillofac Surg. 2003;  41 157-160
• 5 Kovacs A, Kiss G Y, Feher A et al.. Radial forearm flap in maxillo-facial surgery.  Acta Chirurgica Hungarica  1995-6;  35(1-2) 149-158
• 6 Kim D, Orron D E, Skillman J J. Surgical significance of popliteal artery variants: a unified angiographic classification.  Ann Surg. 1989;  210 776
• 7 Margiotta M S, Markowitz B, Shaw W. Routine angiography in free fibula flap reconstruction.  Plast Surg Forum. 1997;  20 102
• 8 Lippert H, Pabst R. Arterial Variations in Man: Classification and Frequency. New York; J.F. Bergman Verlag 1985: 60-63
• 9 Disa J J, Cordeiro P G. The current role of preoperative arteriography in free fibula flaps.  Plast Reconstr Surg. 1998;  102 1083-1088
• 10 Smith R B, Thomas R D, Funk G F. Fibula free flaps.  Arch Otolaryngol Head Neck Surg. 2003;  129 712-715