title: A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteocutaneous flaps for head and neck reconstruction.
abstract: BACKGROUND
  In designing an osteocutaneous fibula flap, poor planning, aberrant anatomy, or inadequate perforators may necessitate modification of the flap design, exploration of the contralateral leg, or additional flap harvest. The authors studied the predictive power of computed tomographic angiography in osteocutaneous fibula flap planning and execution.
  
  
  METHODS
  The authors studied a prospective cohort of 40 consecutive patients who underwent preoperative computed tomographic angiography mapping of the peroneal artery and its perforators and subsequent free fibula flap reconstruction of mandibular or maxillary defects. The authors compared their analysis of perforator anatomy, peroneal artery origin, and fibula length with intraoperative clinical findings.
  
  
  RESULTS
  Overall, computed tomographic angiography identified 94.9 percent of the cutaneous perforators found intraoperatively. Clinically, perforators were located an average of 8.7 mm from their predicted locations. The peroneal artery origin from the tibioperoneal trunk averaged 6.0 mm from its predicted location. The average length of the fibula differed from the predicted length by 8.0 mm. Computed tomographic angiography accurately predicted perforators as either septocutaneous or musculocutaneous 93.0 percent of the time. Perforator size was accurately predicted 66.7 percent of the time. Skin islands and osteotomies were modified in 25.0 percent of the cases on the basis of computed tomographic angiography findings. Two patients had hypoplastic posterior tibial arteries, prompting selection of the contralateral leg. There were no total flap or skin paddle losses.
  
  
  CONCLUSIONS
  Computed tomographic angiography accurately predicted the course and location of the peroneal artery and perforators; perforator size was less accurately estimated. Computed tomographic angiography provides valuable information to facilitate osteocutaneous fibula flap harvest.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.forename: John E
authors.initials: JE
authors.lastname: Madewell
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000637:transplantation; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014945:Wound Healing / Q000502:physiology