Evolution in Preoperative Imaging

  • Massimo Pinelli
  • Alberto Puglisi
  • Giorgio De SantisEmail author


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.


Jaw Fibula flap Head and neck reconstruction Instrumental evaluation Angio-CT 


  1. 1.
    Yim KK, Wei FC. Fibula osteoseptocutaneous flap for mandible reconstruction. Microsurgery. 1994;15:245–9.CrossRefGoogle Scholar
  2. 2.
    Disa JJ, Cordeiro PG. The current role of preoperative arteriography in fibula free flaps. Plast Reconstr Surg. 1998;102:1083–8.CrossRefGoogle Scholar
  3. 3.
    Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal artery variants: a unified angiographic classification. Ann Surg. 1989;210:776–81.CrossRefGoogle Scholar
  4. 4.
    Lippert H, Pabst R. Arterial variations in man: classification and frequency. New York: JF Bergman Verlag; 1985. p. 60–3.Google Scholar
  5. 5.
    Kadir S. Arterial anatomy of the trunk and extremities. In: Kadir S, Brothers MF, editors. Atlas of normal and variant angiographic anatomy. Philadelphia: WB Saunders Co; 1991. p. 124.Google Scholar
  6. 6.
    Yamada T, Gloviczi P, Bower TC, Naessens JM, Carmichael SW. Variations of arterial anatomy of the foot. Am J Surg. 1993;166:130–5.CrossRefGoogle Scholar
  7. 7.
    Lutz BS, Wei FC, Ng SH, Chen SHT. Routine donor leg angiography before vascularized free fibula transfer is not necessary: a prospective study in 120 clinical cases. Plast Reconstr Surg. 1999;103:121–7.CrossRefGoogle Scholar
  8. 8.
    Young DM, Trabulsy PP, Anthony JP. The need for preoperative leg angiography in fibula free flaps. J Reconstr Microsurg. 1994;10:283–9.CrossRefGoogle Scholar
  9. 9.
    Blackwell KE. Donor site evaluation for fibula free flap transfer. Am J Otolaryngol. 1998;19:89–95.CrossRefGoogle Scholar
  10. 10.
    Klein S, Hage JJ, van der Horst CM, Lagerweij M. Ankle-arm index versus angiography for the reassessment of fibula free flap. Last Reconstr Surg. 2003;111:735–43.CrossRefGoogle Scholar
  11. 11.
    Hessel SJ, Adams DF, Abrams HL. Complications of angiography. Radiology. 1981;138:273–81.CrossRefGoogle Scholar
  12. 12.
    Manaste BJ, Coleman DA, Bell DA. Magnetic resonance imaging of vascular anatomy before vascularized fibula grafting. J Bone Joint Surg Am. 1990;72:409–14.CrossRefGoogle Scholar
  13. 13.
    Polak JF. Peripheral arterial disease: evaluation with color flow and duplex sonography. Radiol Clin N Am. 1995;33:71–90.PubMedGoogle Scholar
  14. 14.
    Smith RB, Thomas RD, Funk GF. Fibula free flaps: the role of angiography in patients with abnormal results on preoperative color flow doppler studies. Arch Otolaryngol Head Neck Surg. 2003;129:712–5.CrossRefGoogle Scholar
  15. 15.
    Ciocca L, Mazzoni S, Fantini M, Persiani F, Marchetti C, Scotti R. CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg. 2012;40:e511–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Massimo Pinelli
    • 1
  • Alberto Puglisi
    • 1
  • Giorgio De Santis
    • 1
    Email author
  1. 1.Plastic and Reconstructive Surgery UnitUniversity Hospital of ModenaModenaItaly

Personalised recommendations