Abstract
IntroductionAnatomical abnormalities in the lower limb vessels are uncommon. However, the preoperative evaluation of the anatomical variations is very important for planning the operation procedure to prevent jeopardizing the donor leg.Case presentationIn this case report, a 23-year-old Asian woman who was scheduled to have vascularized free fibula transplantation for reconstruction of her wrist after excision of bone tumor in her distal radius, was found to have congenital aplastic posterior tibial arteries in both legs. These findings were found on magnetic resonance angiography (our preferred methodology due to its simplicity). We planned testing the sufficiency of her pedal pulses after temporarily clamping her peroneal artery but prior to harvesting, to ensure minimal risk to the longevity of her donor leg. During the operation, after dissection of a 10cm segment of her fibula with the peroneal artery, the peroneal artery proximal to the graft was temporarily clamped and the tourniquet was released. As adequate sustainable pedal pulses were confirmed, the graft was harvested and transplanted to her wrist. There was no morbidity in her right leg postoperatively and the union of the grafted fibula was substantiated 10 months postoperatively.ConclusionsWe concluded two findings: firstly, for accurate preoperative planning of a vascularized free fibula procedure, examination of the bilateral lower leg vasculature either by angiography or other imaging should be performed. Secondly, abnormalities are not in themselves reason to abandon the vascularized free fibula procedure. We contend that pedal pulses should be evaluated preoperatively and provided that adequate foot circulation can be confirmed (by temporarily clamping the vessels and releasing the tourniquet during the operation prior to harvesting the free vascularized fibula) the procedure should be successful without jeopardizing the donor leg.
Highlights
Anatomical abnormalities in the lower limb vessels are uncommon
We contend that pedal pulses should be evaluated preoperatively and provided that adequate foot circulation can be confirmed the procedure should be successful without jeopardizing the donor leg
Case presentation A magnetic resonance angiography (MRA) of a 23-year-old Asian woman who was scheduled for a vascularized free fibula transplantation to reconstruct her left wrist after excision of a giant cell tumor in her distal radius (Figure 1A and B) showed a congenital aplastic posterior tibial artery (PTA) in her right lower leg (Figure 2)
Summary
We conclude two findings: firstly, that for accurate preoperative planning of a vascularized free fibula procedure, examination of the bilateral lower leg vasculature either by angiography or other imaging should be performed. Provided adequate foot circulation can be confirmed by temporarily clamping the vessels and releasing the tourniquet during the operation prior to harvesting the free vascularized fibula, the procedure should be successful. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. Authors’ contributions TK and IN were major contributors in harvesting the vascularized free fibula and in writing the manuscript. IF and TF analyzed and interpreted the patient data and performed the excision of the tumor and bone fixation of the fibula. MS performed the analysis of MRA and magnetic resonance imaging.
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