Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment

Foot Ischemia After a Free Fibula Flap Harvest

“…7 As a result, numerous studies have stressed the need to demonstrate the arterial condition of the donor site before the operation by using various imaging methods. [7][8][9] The advantages, disadvantages, and strengths of angiography, CD, and MRA were compared in previous studies. 6,[8][9][10] Some authors stated that physical examination of the pulse solely was sufficient.…”

“…6 Numerous authors have suggested and discussed the efficacy of the use of imaging methods including color Doppler (CD) echocardiography, MR angiography (MRA), and conventional angiography before flap harvest. [6][7][8][9][10][11] We herein present a patient who developed a catastrophic lower extremity ischemia after fibula flap harvest despite a normal preoperative CD study. The report will also describe the vascular reconstruction performed by cardiovascular surgeons to perfuse the foot and to facilitate wound healing.…”

Chronic Thrombosis in the Descending Genicular Artery during Harvest of a Medial Femoral Condyle Corticocancellous Flap: A Case Report

“…On the basis of these findings, routine preoperative imaging with its inherent costs and risks to the patient has been deemed by some to be unjustified. However, given the potential devastating complications of lower extremity ischemia, the cost associated with free flap failure, and the potential for anatomic variability, other authors recommend the use of preoperative imaging before free flap harvest [6]. Fig.…”

“…2 Oblique radiograph of the humerus following humeral debridement and antibiotic-impregnated spacer placement Fig. 3 Vessel pathology at×100 magnification demonstrating a thrombosed fibrin-filled artery To avoid the potential risks associated with the contrast administration and radiation, high-resolution magnetic resonance angiography has been offered as a reasonable and safe alternative to digital subtraction angiography [6]. Fortunately, even with the sacrifice of a large caliber vessel, ischemic complications to the lower extremity are rare.…”

Feasibility of Microvascular Head and Neck Reconstruction in the Setting of Calcified Arteriosclerosis of the Vascular Pedicle

“…This is a wellknown consideration during the preoperative evaluation of lower-extremity donor sites such as the fibula osteocutaneous free flap, and preoperative vascular imaging studies are often performed in these patients to rule out the possibility of occluded or stenotic vessels and to evaluate for atherosclerotic vascular malformation. 12 Furthermore, vessels affected by atherosclerotic changes often develop associated vascular calcifications leading to a loss of vessel elasticity and compliance. 13 In these patients, the loss of elasticity in the anastamotic vessels may render the arrangement of ideal pedicle geometry particularly challenging.…”