Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer.
BACKGROUND
In harvesting free fibula composite flaps, preoperative knowledge of the lower limb vascular anatomy is essential to prevent ischaemic complications or flap failure. Magnetic resonance angiography (MRA) allows imaging of the septocutaneous perforators (< or = 1-2mm diameter) of the peroneal artery used in the free fibula flap.


METHODS
We investigated seven patients undergoing the free fibula flap preoperatively with high-resolution MRA images to study the following: 1) tibio-peroneal anatomy, 2) peripheral artery disease, 3) the positions of the perforator vessels on the peroneal artery and their course in the posterolateral intermuscular septum and 4) the cutaneous distribution of the perforators, and to compare them to surgical findings.


RESULTS
MRA demonstrated tibio-peroneal anatomy in sufficient detail to exclude anatomic variants and significant peripheral vascular disease, detected septocutaneous perforators arising from the peroneal artery coursing in the posterolateral intermuscular septum and determined the skin terminus of the septocutaneous perforators. All septocutaneous perforators found during surgery were detected prospectively on high-resolution MRA.


CONCLUSIONS
Lower leg vascular anatomy assessment with high-resolution MRA determined the location of the septocutaneous perforators of the peroneal artery preoperatively with accuracy and precision. This anatomical knowledge provides for a safer procedure and the opportunity to plan surgical details preoperatively.
Fukaya
Eri
E
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo 162 8666, Japan. fukaya@prs.twmu.ac.jp
Saloner
David
D
Leon
Pablo
P
Wintermark
Max
M
Grossman
Richard F
RF
Nozaki
Motohiro
M
D000328:Adult; D000368:Aged; D001158:Arteries / Q000033:anatomy & histology; D005260:Female; D005360:Fibula / Q000098:blood supply*; D006801:Humans; D007866:Leg / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000098:blood supply; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting