Preoperative Vascular Interventions to Improve Donor Leg Perfusion: a Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction

Publication date: Available online 1 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Roderick Y. Kim, Jason N. Burkes, Harshal S. Broker, Fayette C. Williams

Abstract

Purpose

For the reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of three vessel run-off leading to post-operative vascular compromise of the lower extremity. Atherosclerosis is the most common disease which can limit the use of this donor site. In general, vascular interventions, which includes angioplasty, atherectomy, and stenting, have been utilized to fix the arterial supplies using endovascular methods. The purpose of this study was to report the outcome of preliminary cohort of patients following vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.

Materials and Methods

We designed a single institution retrospective case review, obtained from electronic medical records. The study population was composed of patients that received fibula free flap for head and neck reconstruction from 2015-2017. Inclusion criteria was patients that obtained conventional angiography and required vascular interventions. There were no specific exclusion criteria. Primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of the reconstruction, and perioperative donor or recipient site complications.

Results

We identified 2 subjects who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery. The mean age was 65, and both patients underwent resection and reconstruction for mandibular carcinoma. Both fibula flaps were from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of their split thickness skin graft. No long-term functional deficit was noted.

Conclusions

Vascular interventions may be a safe method to re-establish vascular flow and three-vessel run-off for select patients initially unable to undergo fibula free flap harvest.

https://ift.tt/2SFxzb5