Abstract
Computed tomography angiography (CTA) is widely used in preoperative evaluation of the lower limbs’ vascular system for virtual surgical planning (VSP) of fibula free flap (FFF) for jaw reconstruction. The present retrospective clinical study analysed n = 72 computed tomography angiographies (CTA) of lower limbs for virtual surgical planning (VSP) for jaw reconstruction. The purpose of the investigation was to evaluate the morphology of the fibular bone and its vascular supply in CTA imaging, and further, the amount and distribution of periosteal branches (PB) and septo-cutaneous perforators (SCPs) of the fibular artery. A total of 144 lower limbs was assessed (mean age: 58.5 ± 15.3 years; 28 females, 38.9%; 44 males, 61.1%). The vascular system was categorized as regular (type I-A to II-C) in 140 cases (97.2%) regarding the classification by Kim. Absent anterior tibial artery (type III-A, n = 2) and posterior tibial artery (type III-B, n = 2) were detected in the left leg. Stenoses were observed mostly in the fibular artery (n = 11), once in the anterior tibial artery, and twice in the posterior tibial artery. In total, n = 361 periosteal branches (PBs) and n = 231 septo-cutaneous perforators (SCPs) were recorded. While a distribution pattern for PBs was separated into two clusters, a more tripartite distribution pattern for SCPs was found. We conclude that conventional CTA for VSP of free fibula flap (FFF) is capable of imaging and distinguishing SCPs and PBs.
Highlights
Fourteen years after the first description of the free fibula flap (FFF) by Taylor in1975 [1], the FFF was used for mandibular reconstruction by Hidalgo [2]
Over the past three decades, there has been debate about the best technique for vascular evaluation of fibular grafts [54], which was abandoned in favor of the CT for virtual surgical planning (VSP), which can be modified as Computed tomography angiography (CTA)
In the evaluated sample of n = 144 lower limbs, a majority of 88.9% (n = 128) were assigned as type I-A concerning the classification by Kim [52], and four limbs (2.8%) with dominant fibular artery (FA) variants were found
Summary
1975 [1], the FFF was used for mandibular reconstruction by Hidalgo [2] This flap is reliable and widely applicable in reconstructive surgery [3]. It offers the possibility of reconstructing both bony and soft tissue defects with a free flap from only one donor site. The FFF can be shaped to almost an ideal form of the missing parts of the jaw and represents the gold standard in mandibular reconstruction [4]. It increases the patient’s quality of life after ablative cancer surgery [5,6]. The osseous FFF facilitates prosthetic rehabilitation with dental implants with stable long-term results [7,8]
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