Evolution in Preoperative Imaging

Abstract

The patency of the major vessels in the donor lower limb should be evaluated before the fibula is harvested because the blood supply can be inadequate for safe utilization of this flap.

History and physical examination are not helpful in detecting most congenital vascular and bone anomalies that would place the foot at high risk for ischemia if the peroneal artery is sacrificed.

The extent of preoperative technological assessment prior to performing a fibula free flap is controversial. Some authors do not think that routine pre-op imaging is indicated. Patients undergoing a partial jawbone reconstruction are often at high risk for peripheral vascular disease due to smoking and advanced age. Significant atherosclerotic disease may be detected, and this suggests the side of fibula harvest or the need for alternative reconstructions. Bone and vascular disorders could greatly affect the final result and could expose the patient to very important complications. This is the reason that instrumental investigations are so important before surgery. Both the recipient and the donor area must be studied.