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

Rahmel, B.; Snow, Thomas; Batstone, Martin

doi:10.1055/s-0030-1270531

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…Preoperative angiography of both legs should be carried out routinely to specify the distribution of blood vessels in the donor area. Anatomic variations where peroneal artery is absent or is the dominant artery supplying the leg and foot (known as peroneal arteria magna) should be detected in advance, otherwise harvest failure or ischemia of the distal limb would happen [7]. Preoperative angiography is more necessary for patients with comorbidities.…”

Section: Donor-site Morbiditiesmentioning

confidence: 99%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.

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Section: Donor-site Morbiditiesmentioning

confidence: 99%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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“…Most variation results from non-standard arterial division, aplasia, or hypoplasia. However, these variations are extremely rare for the peroneal artery [ 6 ]. Although these anomalies may still be encountered by reconstructive surgeons, radiologists, and other lower limb surgeons, if one is vigilant.…”

Section: Discussionmentioning

confidence: 99%

The “Lost” Peroneal Vessel – A Rare Anatomical Variation in Free Fibula Flap Harvest

Giri,

Rajpoot,

Suba

et al. 2023

jocr

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Introduction: Vascularized free fibula flap is one of the commonly used flaps in autologous soft-tissue and osseous reconstructions in the modern era. While there is abundant literature available on the variable branching pattern and course of the popliteal artery, tibial arteries, and dorsalis pedis artery, there is a paucity of text available on the not-so-common peroneal vessels. Case Report: A case of a 60-year-old male who was diagnosed with carcinoma of buccal mucosa with involvement of the mandible of the right side was planned for wide local excision with modified radical neck dissection and resurfacing of the resultant defect using a contralateral free fibula osseocutaneous free flap. Intraoperatively, the peroneal vessels were noted to have a premature termination along the lateral border of distal one-third of the fibula, after giving a communicating branch to an anterior tibial artery. The flap was raised based on the same pedicle, without ligating any distal portion of the vessel. Reconstruction of the defect and post-operative recovery was uneventful. Full flap survival was observed. Conclusion: We report this case as this vascular “anomaly” is one of its kind and has been oblivious to the literature and practicing microsurgeons globally. Keywords: Osseocutaneous free flap, peroneal vessel anomaly, reconstruction.

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“… 4 Other novel approaches have been cited in the literature: one case report detailed the use of preoperative balloon occlusion to assess distal limb ischemia in the setting of PAM. 14 …”

Section: Discussionmentioning

confidence: 99%

“…4 Other novel approaches have been cited in the literature: one case report detailed the use of preoperative balloon occlusion to assess distal limb ischemia in the setting of PAM. 14 For surgeons who opt to use preoperative imaging, the knowledge of a PAM may alter the surgical plan. A systematic review reported that in 21 of the 28 cases of a dominant PA in FFF, surgeons altered their plan and did not to utilize the affected leg in 17 of 21 patients.…”

Section: Discussionmentioning

confidence: 99%

FFF Utilizing an Arteriovenous Vascular Loop of Two Peroneal Venae Comitantes for a PAM

Huddleston¹,

Kurtzman²,

Koehler³

2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Vascularized bone grafting is widely used for reconstruction of osseous defects of the forearm. Fibular free flap (FFF) is one option, which relies on harvesting the peroneal artery. This procedure is subject to lower extremity anatomic variants; therefore, some recommend preoperative angiography. However, high quality evidence for this approach and its cost-effectiveness are lacking and instead one can diligently assess the vascular anatomy intraoperatively. Here, we describe a case of a 73-year-old man who was found to have a peronea arteria magna intraoperatively during an FFF for a left radius reconstruction secondary to an infectious nonunion. We describe an approach to performing an FFF using an arteriovenous vascular loop through the fibula employing the two accompanying peroneal venae comitantes. The patient had no complications and was found to have appropriate healing of the upper extremity without lower extremity compromise at 3-month follow-up. This report illustrates an alternative to using an interpositional venous graft for peronea arteria magna found intraoperatively during FFFs.

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

Cited by 9 publications

References 7 publications

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

The “Lost” Peroneal Vessel – A Rare Anatomical Variation in Free Fibula Flap Harvest

FFF Utilizing an Arteriovenous Vascular Loop of Two Peroneal Venae Comitantes for a PAM

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