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J Reconstr Microsurg 2007; 23(4): 205-211
DOI: 10.1055/s-2007-981501
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Magnetic Resonance Angiography for Free Fibula Flap Transfer

Eri Fukaya1 , 3 , Richard F. Grossman2 , David Saloner3 , Pablo Leon2 , Motohiro Nozaki1 , Stephen J. Mathes2
  • 1Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
  • 2Division of Plastic Surgery, San Francisco, California
  • 3Department of Radiology, University of California San Francisco, San Francisco, California
Further Information

Publication History

Publication Date:
25 May 2007 (online)

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ABSTRACT

Recent refinements of magnetic resonance angiography (MRA) allow imaging vessels as small as the septocutaneous perforators (≤ 1 to 2 mm diameter), but a Medline review reveals no report of septocutaneous vessel imaging for free flap surgery. Challenges in fibula free flap preparation include knowledge of: (1) tibioperoneal anatomy, (2) the positions of the perforator vessels on the peroneal artery and their course in the posterolateral intermuscular septum, and (3) the cutaneous distribution of the perforators. Questioning whether high-resolution MRA could image these, we studied the lower extremities of nine healthy volunteers. MRA demonstrated tibioperoneal anatomy in sufficient detail to exclude anatomic variants and significant peripheral vascular disease and showed septocutaneous perforators arising from the peroneal artery and coursing in the posterolateral intermuscular septum to the skin. High-resolution MRA provided anatomic and clinical information that conventionally has been impossible to obtain preoperatively or has required multiple tests, often of an invasive nature.

KEYWORDS

Free fibula flap - septocutaneous perforator - MRA

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Richard F GrossmanM.D. 

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