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Preoperative Evaluation of Lower Extremity Arteries for Free Fibula Transfer Using MDCT Angiography

Jin, Kwang Nam MD*; Lee, Whal MD*; Yin, Yong Hu MD*; Choi, Sang-Il MD; Jae, Hwan Jun MD*; Chung, Jin Wook MD*; Park, Jae Hyung MD*

Journal of Computer Assisted Tomography: September-October 2007 - Volume 31 - Issue 5 - p 820-825
doi: 10.1097/RCT.0b013e318033defd
Musculoskeletal/Extremity Imaging: Original Article

We discuss the preoperative application of computed tomographic (CT) angiography to identify legs suitable for free fibular flaps.

Methods: The condition of 118 consecutive patients was prospectively evaluated by means of CT angiography for planned free fibula flap reconstructions. We retrospectively investigated whether fibular free flap transfer was performed in candidate patients and whether the presence of postoperative foot ischemia had been followed.

Results: Multidetector row CT angiography demonstrated a normal arterial anatomy in 82 patients, anatomical variants in 30 patients, and peripheral arterial occlusive disease in 6 patients. The radiologists selected 20 legs as major variants that cannot ensure lower extremity viability after flap harvest. Sixty-three patients underwent fibula free flap transfer. The surgeons followed our imaging diagnosis and selected healthy legs as candidates for fibular free transfer in all but 2 patients. No postoperative foot ischemia presented in any patient.

Conclusions: Computed tomographic angiography is a reliable preoperative imaging technique for the selection of appropriate legs as candidates for fibular free transfer.

From the *Department of Radiology, Seoul National University College of Medicine, the Institute of Radiation Medicine, Clinical Research Institute, Seoul National University Hospital; and †Department of Radiology, Seoul National University Bundang Hospital, Seoul, South Korea.

Received for publication November 7, 2006; accepted January 9, 2007.

Reprints: Whal Lee, MD, Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Korea (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.