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European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 2/2021

01-04-2021 | Angiography | Case Report

Fibula free flap with type IIIB popliteal artery branching: a case report and recommendations

Authors: Noah M. Betar, Shiva S. Subramaniam, Scott C. Borgna

Published in: European Journal of Plastic Surgery | Issue 2/2021

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Abstract

Planning for fibula free flap (FFF) reconstruction generally involves preoperative vascular imaging by computed tomographic angiography, magnetic resonance angiography or digital subtraction angiography to identify congenital variants or acquired pathology that contraindicate flap harvest. Two cases of successful FFF without ischaemic donor site morbidity in legs with type IIIB popliteal artery branching and no cases of unsuccessful harvest exist in the literature, suggesting the safety of harvesting a fibula free flap in these cases. We present a case where attempted FFF harvest in a leg with known type IIIB popliteal artery branching was aborted due to intraoperative evidence of inadequate peripheral perfusion measured by great toe pulse oximetry. There are no recommendations for additional testing to determine safety of FFF harvest in legs with type IIIB anatomy, with most authors considering this a contraindication to raising a FFF. We recommend preoperative functional testing by balloon angiography to assess the adequacy of collateral circulation where harvest of FFF is considered in legs with type IIIB popliteal branching.
Level of evidence: Level V, therapeutic study.
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Metadata
Title
Fibula free flap with type IIIB popliteal artery branching: a case report and recommendations
Authors
Noah M. Betar
Shiva S. Subramaniam
Scott C. Borgna
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Keyword
Angiography
Published in
European Journal of Plastic Surgery / Issue 2/2021
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-020-01673-5

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