VIDEO: Preoperative CT Angiography for Fibular Free Flap Reconstructions
Bilal Mujtaba, Gaurav K. Synghal, Patrick B. Garvey, Behrang Amini, Tamara Miner Haygood, John E. Madewell, Colleen M. Costelloe American Journal of Roentgenology. 2018;210:W264. 10.2214/AJR.17.19154
OBJECTIVE: The objective of this video article is to provide an introduction to the use of fibular free flaps. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and CT angiography interpretation, computer-assisted design and manufacturing, and the limitations of the fibular free flap.
CONCLUSION: The fibular free flap is commonly used for head and neck reconstructive surgery. Variation exists between individuals regarding the origin of the peroneal artery and the perforating arteries. Our method of performing CT angiography and reporting its findings for patients undergoing a fibular free flap procedure provides a reproducible means of identifying important elements of the vasculature and effectively communicating their locations to surgeons. Accurate communication can maximize the success of the flap harvesting and the preoperative manufacture of custom fibular cutting guides.