Subscribe to RSS
DOI: 10.1055/s-0042-1744411
A Lucky Case of Successful Free Fibula Osteocutaneous Flap Harvest in Peronea Arteria Magna
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.
Author Contributions
Conceptualization: M.A.R., W.A.W.S., A.S.H. Data curation: M.A.R., W.A.W.S. Formal analysis: M.A.R., W.A.W.S., A.S.H. Funding acquisition: None. Methodology: M.A.R., W.A.W.S., A.S.H. Project administration: M.A.R., W.A.W.S., A.S.H. Writing - original draft: M.A.R. Writing - review and editing: all authors.
Ethical Approval
The study was performed in accordance with the principles of the Declaration of Helsinki. Written informed consents were obtained.
Patient Consent
The patients provided written informed consent for the publication and the use of their images.
Publication History
Article published online:
06 April 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
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
- 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
- 3 Hidalgo DA. Fibula free flap, plastic and reconstructive surgery. Plast Reconstr Surg 1989; 84 (02) 71-79
- 4 Lippert H, Pabst R. Arterial Variations in Man. München: 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
- 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
- 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
- 8 Hölzle 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
- 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
- 10 Rosson GD, Singh NK. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg 2005; 21 (08) 533-538
- 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
- 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
- 13 Disa JJ, Cordeiro PG. The current role of preoperative arteriography in free fibula flaps. Plast Reconstr Surg 1998; 102 (04) 1083-1088
- 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