Summary
Objective
The fibular myocutaneous flap is a classic flap used to reconstruct oral and maxillofacial
defects. This study aimed to evaluate the effectiveness of high-frequency color Doppler
ultrasound in detecting the blood vessels in the fibular myocutaneous flap, analyze
the influence of variations in the peroneal vessels and perforating peroneal arteries
on the surgical design, and explore the value of this technology in preoperatively
assessing the blood vessels of the fibular myocutaneous flap.
Methods
Twenty-five patients with mandibular disease or defect underwent preoperative evaluation
of the blood vessels of the calf by high-frequency color Doppler ultrasound. The inner
diameter and peak systolic velocity (PSV) of the peroneal arteries and veins and the
perforating peroneal arteries were compared between different groups. The consistency
between the perforating peroneal arteries marked by ultrasonography and the intraoperative
findings was analyzed.
Results
The initial segment of the peroneal artery had a larger inner diameter (p<0.001) and lower PSV (p<0.05) than the middle segment. The perforating peroneal arteries were mainly distributed
in the middle of the fibula. The inner diameter of the perforating peroneal artery
was larger in men than in women (p<0.05). In comparison with surgical exploration as the gold standard, high-frequency
color Doppler ultrasound results showed good consistency (Kappa=0.684, 95% CI: 0.512–0.856,
p<0.001), with a sensitivity of 89.36%, specificity of 78.57%, and accuracy of 85.33%.
Conclusion
High-frequency color Doppler ultrasound can detect, quantitatively evaluate, and accurately
mark the peroneal artery and vein and perforating peroneal artery before fibular myocutaneous
flap transplantation.
Keywords
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References
- Mandibular reconstruction with vascularized bone flaps: a systematic review over 25 years[J].British Journal of Oral and Maxillofacial Surgery. 2017; 55: 113-126
Ahmad K, Farzad Borumandi. Anatomical variants of lower limb vasculature and implications for free fibula flap: systematic review and critical analysis[J]. Wiley Periodicals Microsurgery, 2016, 36:165-172.
- Preoperative Imaging for Perforator Flaps in Reconstructive Surgery: a systematic review of the evidence for current techniques[J].Annals of Plastic Surgery. 2012; 69: 3-9
- Surgical significance of popliteal artery variants: a unified angiographic classification[J].Ann Surgical. 1989; 210: 776-781
- Anatomy of the vasculature of the lower leg and harvest of a fibular flap: a systematic review[J].British Journal of Oral and Maxillofacial Surgery. 2017; 55: 904-910
- Application of microvascular anastomotic device for fibular flap transfer in reconstruction of oral and maxillofacial defects[J].China J Oral Maxillofac Surg. 2015; 13: 348-351
- Preoperative three-dimensional reconstruction in vascularized fibular flap transfer[J].Journal of Cranio-Maxillo-Facial Surgery. 2012; 40: 599-603
- Reference values of vessel diameters, stenosis prevalence, and arterial variations of the lower limb arteries in a male population sample using contrast-enhanced MR angiography[J].PLoS ONE. 2018; 13: 1-15
- The Value of Color Doppler Ultrasound in Evaluation of the Recipient Vessels in Reconstruction of Oral and Maxillofacial Defects with Free Flap[J].Chinese J Ultrasound Med. 2018; 34: 871-873
- Non-invasive vascular imaging in perforator flap surgery[J].Acta Radiological. 2013; 54: 89-98
- Is distal fibular fracture an absolute contraindication to free fibular flap harvesting? A review of evidence in the literature and illustration by a successful case[J].Wiley Periodicals Microsurgery. 2015; 35: 60-63
- Peroneal flap: Clinical application and cadaveric study[J].Archives of Plastic Surgery. 2017; 44: 136-143
- Magnetic resonance angiography for free fibula harvest: anatomy and perforator mapping[J].Oral and Maxillofacial Surgeons. 2019; 9: 1-7
- Anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap[J].China J Microsurg. 2009; 32: 113-115
- Perforators of the fibular artery and suprafascial network[J].Surgery Radiology Anatomy. 2018; 40: 927-933
- A Prospective Study of Preoperative Computed Tomographic Angiographic Mapping of Free Fibula Osteocutaneous Flaps for Head and Neck Reconstruction[J].Plastic and Reconstructive Surgery. 2012; 130: 541-549
- An anatomic study of vascularized fibular grafts[J].Chinese Journal of Traumatology. 2008; 11: 279-282
- Ankle osteoarthritis: a rare complication after free fibular flap harvesting[J].Formosan Journal of Surgery. 2015; 48: 17-20
- Reliability of color Doppler ultrasound imaging for the assessment of Anterolateral Thigh Flap perforators: A prospective study of 30 perforators[J].Plastic and Reconstructive Surgery. 2018; 141: 762-766
Article info
Publication history
Published online: August 23, 2022
Accepted:
August 17,
2022
Received:
April 18,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
