Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Lucky Case of Successful Free Fibula Osteocutaneous Flap Harvest in Peronea Arteria Magna

  • Published : 2022.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.

Keywords

References

  1. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55(05):533-544 https://doi.org/10.1097/00006534-197505000-00002
  2. Longo B, Sorotos M, Nicolotti M, Santanelli di Pompeo F. Retrospective analysis of incidence of peroneal artery hypoplasia in 101 free fibula transfers and new classification of popliteal branch anomalies. Injury 2014;45(02):394-398 https://doi.org/10.1016/j.injury.2013.09.027
  3. Hidalgo DA. Fibula free flap, plastic and reconstructive surgery. Plast Reconstr Surg 1989;84(02):71-79 https://doi.org/10.1097/00006534-198907000-00014
  4. Lippert H, Pabst R. Arterial Variations in Man. Munchen: J.F. Bergmann Verlag; 1985
  5. Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal arterial variants. A unified angiographic classification. Ann Surg 1989;210(06):776-781 https://doi.org/10.1097/00000658-198912000-00014
  6. Abou-Foul AK, Borumandi F. Anatomical variants of lower limb vasculature and implications for free fibula flap: systematic review and critical analysis. Microsurgery 2016;36(02):165-172 https://doi.org/10.1002/micr.30016
  7. Lutz BS, Wei FC, Ng SH, Chen IH, Chen SHT. Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases. Plast Reconstr Surg 1999;103(01):121-127 https://doi.org/10.1097/00006534-199901000-00019
  8. Holzle F, Ristow O, Rau A, et al. Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment. Br J Oral Maxillofac Surg 2011;49(04):275-280 https://doi.org/10.1016/j.bjoms.2010.05.003
  9. Kelly AM, Cronin P, Hussain HK, Londy FJ, Chepeha DB, Carlos RC. Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making. Am J Roentgenol 2007;188(01):268-274 https://doi.org/10.2214/AJR.04.1950
  10. Rosson GD, Singh NK. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg 2005;21(08):533-538 https://doi.org/10.1055/s-2005-922432
  11. Mast BA. Comparison of magnetic resonance angiography and digital subtraction angiography for visualization of lower extremity arteries. Ann Plast Surg 2001;46(03):261-264 https://doi.org/10.1097/00000637-200103000-00010
  12. Koelemay MJ, Lijmer JG, Stoker J, Legemate DA, Bossuyt PM. Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis. JAMA 2001;285(10):1338-1345 https://doi.org/10.1001/jama.285.10.1338
  13. Disa JJ, Cordeiro PG. The current role of preoperative arteriography in free fibula flaps. Plast Reconstr Surg 1998;102(04):1083-1088 https://doi.org/10.1097/00006534-199809020-00025
  14. Young DM, Trabulsy PP, Anthony JP. The need for preoperative leg angiography in fibula free flaps. J Reconstr Microsurg 1994;10(05):283-28 https://doi.org/10.1055/s-2007-1006596