The role of angiography in the lower extremity using free vascularized fibular transplants for mandibular reconstruction.
BACKGROUND
Fibular osteocutaneous free tissue transfer represents the work horse procedure in the reconstruction of large oromandibular defects. Before the fibula is harvested the blood supply of the lower leg and foot should be examined, as the perfusion may be based predominantly on the peroneal artery and venae comitantes. To avoid postoperative ischaemia of the lower leg, adequate perfusion must be guaranteed before sacrificing the peroneal vessels. Anatomical variations and peripheral arterial occlusive disease add to the risk of ischaemia. Various methods of evaluating the blood supply have been described.


METHODS
Fifty-two consecutive cases of fibular flaps were evaluated to study the arterial blood supply of the lower extremity. For angiography, the right femoral artery was punctured using the Seldinger technique and a total of 20-25 ml contrast medium (Imeron 300) was infused and images required at a rate of 0.5/sec.


RESULTS
A patent three-vessel supply to both feet could only be detected in 21 patients. Thirty-one angiograms revealed anatomic and/or arteriosclerotic alterations. Angiography provided accurate information in all patients and allowed successful fibular transfer in those patients who were found preoperatively to have regular conditions.


CONCLUSIONS
Preoperative assessment of the blood supply of the lower extremity is important before fibular osteocutaneous free tissue transfer. We advocate angiography as interpretation is not examiner dependent.
Kessler
P
P
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Erlangen, Germany. peter.kesseler@mkg.uni-erlangen.de
Wiltfang
J
J
Schultze-Mosgau
S
S
Lethaus
B
B
Greess
H
H
Neukam
F W
FW
D000328:Adult; D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D016025:Bone Transplantation / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003287:Contrast Media; D005260:Female; D005263:Femoral Artery; D005360:Fibula / Q000098:blood supply; D005528:Foot / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D007866:Leg / Q000098:blood supply*; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D018482:Muscle, Skeletal / Q000637:transplantation; D011183:Postoperative Complications / Q000517:prevention & control; D012039:Regional Blood Flow / Q000502:physiology; D016038:Skin Transplantation / Q000473:pathology; D013524:Surgical Flaps; D016909:Tibial Arteries / Q000000981:diagnostic imaging*; D014654:Vascular Patency / Q000502:physiology
D003287:Contrast Media