Preoperative magnetic resonance angiography in fibular-free flap reconstruction of head and neck defects.
BACKGROUND
Conventional angiography has been recommended for imaging of the leg prior to fibular-free flap harvest. Magnetic resonance angiography (MRA) offers a similar level of accuracy at no risk to the patient and at a lower cost.


METHODS
Thirty-two patients who were considered for fibular-free flap were retrospectively reviewed. Preoperative MRA of the lower extremities was performed on all patients and used to evaluate vessel patency. The decision of free flap donor site was based upon MRA findings.


RESULTS
The choice of side harvested was changed in four (12.5%) patients and the fibula was excluded as a donor site in three patients (9%). Flap design was altered in one patient found to have abnormally short peroneal arteries. The usual correlation between palpable distal pulses and proximal patent arteries was found to be unreliable. All 29 patients underwent successful free flap reconstruction with no ischemic complications.


CONCLUSIONS
Preoperative MRA is useful when choosing the side of fibular harvesting and in excluding patients from the fibula as a donor site. We feel that the cost of obtaining preoperative imaging is outweighed by avoiding potential ischemic complications and additional operating room time with no risk to the patient's health.
Lorenz
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RR
Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Desk A-71, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Esclamado
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*