Asymptomatic Deep Peroneal Vein Thrombosis During Free Fibula Flap Harvest

Abstract

The free fibula flap is the preferred reconstructive method for oncologic defects of the mandible. Arterial inflow of the extremity is routinely evaluated with several modalities; however, venous screening is rarely performed. Patients with cancer are at elevated risk of occult deep venous thrombosis (DVT). An asymptomatic thrombus encountered during free fibula reconstruction is a serious concern. Although such cases have been reported, we suspect the incidence of DVT during fibula free flap harvest is underappreciated. This monograph uses a case example to review risk factors for occult DVT, present a strategy for preoperative assessment, and provide a reconstructive algorithm to for mandibular reconstruction in such instances.

Deep vein thrombosis in donor or recipient veins encountered during lower extremity reconstruction with a free anterolateral thigh perforator flap: How do we deal with it?

“…Patient No. [13][14][15][16][17]. In these patients, DVT was discovered in the recipient veins of the ALTP flap in two patients and in the donor veins in three patients.…”

“…Several researchers have published their experiences dealing with DVT concerning free flap procedures (2,4,8,(10)(11)(12)(13)(14). Most of them focused on the systemic adverse effects of DVT on venous anastomosis in free flap transfer.…”

“…Nevertheless, there are few reports on the feasibility of using the veins occupied by DVT as recipient veins locally. Furthermore, the reports regarding DVT in donor veins are even fewer, and all of them are case reports on occult DVT in peroneal veins of free osteocutaneous fibula flaps (10)(11)(12)(13). So far, no clinical guidelines are available to cope with DVT in veins to be used for pedicle anastomosis during free ALTP flap transfer.…”

A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap

“…To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. 4 5 6 7 8 Reasons for fibula flap reconstruction in those cases included tumors of the head or neck in four cases, tumor of the lower leg in one case, and multiple facial trauma in one case. None were cases of lower leg trauma as in the present case.…”

“… 3 Spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible; however, to the best of our knowledge, only six cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. 4 5 6 7 8 We present a rare case of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap for reconstruction of segmental bone defects of the tibia, and we discuss possible salvage procedures in this situation.…”