Analysis of Variation in Anatomy of Lower Limb Vasculature and Implications for Free Fibula Flap by Color Doppler Imagin
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ORIGINAL ARTICLE
Analysis of Variation in Anatomy of Lower Limb Vasculature and Implications for Free Fibula Flap by Color Doppler Imaging Digwa Sunnysinh1 • Satyajit Dandagi2 • B. C. Sikkerimath2 • Anu Jose2 Sushmit Priyam Bora2
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Received: 26 September 2020 / Accepted: 7 November 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Background The free fibula flap (FFF) has proved to be an adequate adjunct tool in the reconstruction of defects following cancer ablation. Although various investigation tools in the past have been proved to be adequate to study the blood supply of the various trunks of arteries, for the survival of graft, the color Doppler flow study (CDF) can be done for the accurate examination of various perforators for the same in the lower limbs prior to its harvest. Materials and Methods 40 patients were included in the study and were examined for free fibula flap tissue transfer via color Doppler study for the lower limb perforators. Results In the study, the perforators that are musculocutaneous, septocutaneous and septomusculocutaneous were detected in 80 legs that were examined and all of them had adequate diameter to justify the fact that the graft can be taken for harvesting, except for only two cases where it was found that they were hypoplastic. Conclusion CDF can be a reliable and informative tool in patients planned for free fibula tissue transfer. Also, the skin perforators can be mapped, so as to determine skin paddle inclusion. Keywords Oral lower limb vasculature Color doppler imaging Free fibula flap Perforators
& Sushmit Priyam Bora [email protected] 1
Dental Officer, ECHS Polyclinic, Kolhapur, India
2
Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Navanagar, Bagalkot, Karnataka, India
Introduction The microvascular free fibula flap (FFF) is currently one of the most preferred methods for reconstruction of head and neck defects following ablative onco-surgery [1]. It is ideal for mandibular reconstruction as it provides a large stock of bone with minimal donor site morbidity and is relatively easy to harvest [2]. The patency of major vessels in the donor limb should be evaluated before the harvesting of FFF because the blood supply may be inadequate to safely utilize the flap [3]. The blood supply of the FFF is based on the peroneal artery and the venae comitantes [2]. Also it is important to determine preoperatively, whether adequate perfusion to the donor extremities will persist after sacrifices of the peroneal pedicle [4]. The best method of evaluating preoperatively, the lower limb vasculature is controversial. Femoral angiography has been considered as the gold standard method, however, the current literature advocate less invasive method of assessment such as magnetic resonance angiography (MRA), color flow Doppler (CFD) etc. [2]. CDF proposed by Futran et al. [4] is an alternative technique. It is comparatively less costly, non-invasive and provide an adequate preoperative assessment to asse
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