Magnetic resonance angiography for free fibula harvest: anatomy and perforator mapping

Schuderer, Johannes; Meier, Johannes; Klingelhöffer, Christoph; Gottsauner, Maximilian; Reichert, Torsten E.; Wendl, Christina; Ettl, Tobias

doi:10.1016/j.ijom.2019.09.005

Cited by 13 publications

(13 citation statements)

References 44 publications

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“…We found a bimodal distribution pattern for PBs and three peaks for SCPs in performed CTA for VSP. These patterns are comparable to the results of other studies [21,31,85].…”

Section: What Is the Frequency And Distribution Of Pbs And Scps Of The Fa?supporting

confidence: 91%

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Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

et al. 2021

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Computed tomography angiography (CTA) is widely used in preoperative evaluation of the lower limbs’ vascular system for virtual surgical planning (VSP) of fibula free flap (FFF) for jaw reconstruction. The present retrospective clinical study analysed n = 72 computed tomography angiographies (CTA) of lower limbs for virtual surgical planning (VSP) for jaw reconstruction. The purpose of the investigation was to evaluate the morphology of the fibular bone and its vascular supply in CTA imaging, and further, the amount and distribution of periosteal branches (PB) and septo-cutaneous perforators (SCPs) of the fibular artery. A total of 144 lower limbs was assessed (mean age: 58.5 ± 15.3 years; 28 females, 38.9%; 44 males, 61.1%). The vascular system was categorized as regular (type I-A to II-C) in 140 cases (97.2%) regarding the classification by Kim. Absent anterior tibial artery (type III-A, n = 2) and posterior tibial artery (type III-B, n = 2) were detected in the left leg. Stenoses were observed mostly in the fibular artery (n = 11), once in the anterior tibial artery, and twice in the posterior tibial artery. In total, n = 361 periosteal branches (PBs) and n = 231 septo-cutaneous perforators (SCPs) were recorded. While a distribution pattern for PBs was separated into two clusters, a more tripartite distribution pattern for SCPs was found. We conclude that conventional CTA for VSP of free fibula flap (FFF) is capable of imaging and distinguishing SCPs and PBs.

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“…We found a bimodal distribution pattern for PBs and three peaks for SCPs in performed CTA for VSP. These patterns are comparable to the results of other studies [21,31,85].…”

Section: What Is the Frequency And Distribution Of Pbs And Scps Of The Fa?supporting

confidence: 91%

“…Computed tomography angiography (CTA) [15][16][17][18], digital subtraction angiography (DSA) [9,19], or magnetic resonance angiography (MRA) [9,12,17,20,21] are often used as objective techniques for visualization of the lower limbs vascular status. Today CTA and MRA often replace invasive catheter arteriography [14].…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

et al. 2021

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“…Previous investigations on the study sample revealed a bimodal distribution pattern for PB and three peaks for SCP in performed CTA for VSP ( 48 ). These patterns of distribution are similar to the results of other studies ( 17 , 20 , 92 ).…”

Section: Discussionsupporting

confidence: 92%

“…Computed tomography (CT) scans and DICOM data sets of the donor and recipient sites are required for virtual surgical planning (VSP) and the facilitation of custom-made, laser-melted, patient-specific titanium osteosynthesis plates ( 12 , 13 ), which becomes widespread routine in many reconstructive centers ( 14 ). MRA was found as a reliable and non-invasive technique to identify anatomical variants and arterial stenoses ( 15 , 16 ) without radiation in preoperative FFF planning ( 17 ). But CTA has been shown to be better than MRA for perforator mapping ( 18 ), as well as being more widely available, adequately accurate, and economic ( 19 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning

et al. 2022

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BackgroundVirtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success.MethodThis retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply.ResultA total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs’ vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP.ConclusionIn general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.

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“…The use of high-resolution vascular mapping preoperative tests on microsurgical flaps has been shown to decrease intraoperative complications in flap dissection [ 21 ], decrease overall surgical time and flap harvesting time [ 22 ], facilitate dissection and avoid serious vascular complications [ 23 ] in patients with vascular abnormalities that could not be diagnosed without such vascular tests or only with physical examination [ 22 , 23 , 24 ]. There is published evidence on the improvement of results when performing preoperative vascular mapping studies with MRA and CTA in several microsurgical flaps: fibula flap [ 24 , 25 , 26 , 27 ], deep inferior epigastric perforator flap [ 21 , 22 , 23 , 28 , 29 , 30 , 31 ] and other perforator flaps. The evidence for the use of preoperative vascular mapping tests in RFFF is scarce, with contradictory results.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice

Tousidonis

Escobar

Caicoya

et al. 2021

JCM

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The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone.

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Magnetic resonance angiography for free fibula harvest: anatomy and perforator mapping

Cited by 13 publications

References 44 publications

Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning

Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice

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