Stellenwert der farbkodierten Duplexsonographie zur präoperativen Darstellung der Unterschenkelarterien bei mikrochirurgischem Fibulatransfer

Abstract

In patients being considered for a microsurgical fibular transfer, thorough examination of the vascular supply to the lower leg is indisputably necessary. The aim of this study was to evaluate the validity of color-coded duplex sonography (CCDS) in the assessment of the arteries of the lower leg. In 13 patients needing bony reconstruction of the jaw 22 legs were examined using CCDS. The three arteries of the lower leg were visualized and traced from the ankle to the popliteal fossa. At every arterial segment Doppler sonographic examination was also performed. All 13 patients underwent digital subtraction arteriography (DSA) of the lower extremities, additionally. We were able to visualize and to assess all but one of the arteries using CCDS. In 13 extremities of 9 patients CCDS exhibited a normal vascular supply to the lower leg provided by three regular arteries. DSA confirmed this and the patients underwent fibular transfer. In the other 4 patients a regular vascular situation could not be shown by CCDS because of nonvisualization of arterial segments or pathological findings. Two of these patients received alternative bony transplants. In the remaining two patients angiography exhibited one leg to have a normal three vessel supply, respectively. Fibular transplants could be raised from this leg. In all patients CCDS was able to localize between 3 and 7 perforators branching off the peroneal artery. Their position determined the placement of the skin paddle to be raised with the bone. Further advantages of CCDS were the universal applicability to all patients and the possibility of performing it at our own department. The time required for the examination and the necessity of having adequate technical equipment were the disadvantages. In patients being considered for a microsurgical fibular transplantation, we recommend CCDS of the lower leg as a screening tool for the vascular supply of the lower leg. DSA and MRA are predominantly advocated for those patients, in whom CCDS reveals pathological or uncertain findings.