Limitations of Computed Tomography Angiography in Preoperative Planning of Peroneus Brevis Rotational Flap.

Abstract

Twenty-five patients who underwent bilateral lower extremity CTAs using standard lower extremity protocol were retrospectively identified. Axial two-dimensional images were scanned craniocaudally using our institution's standard CT image viewing software, Merge Radsuite (Merge Healthcare, Hartland, Wis.). The average location of distal-most PB perforators identified on CT angiogram was 13.1 ± 5.1 cm proximal to the distal fibula, or 34.5% ± 13.5% of total fibular length. Standard CTA was only able to locate a pedicle within 8 cm of the lateral malleolus (20.9% of fibular length) in three of 25 patients (12%). Previous studies have described a reliable pedicle within 8 cm of the distal fibular tip upon which to design a distally based PB rotational flap. The absence of such perforators in the CT angiogram suggests that standard CT angiogram is not a reliable technique for identifying the patency of such perforators when evaluating the utility of a distally based PB flap.