Computed Tomography Angiography (CTA) Before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2021 Oct 23

PMID 34679563

Citations 5

Authors

Michael Knitschke

Anna Katrin Baumgart

Christina Backer

Christian Adelung

Fritz Roller

Daniel Schmermund

Sebastian Bottger

Hans-Peter Howaldt

Sameh Attia

Affiliations

Soon will be listed here.

Abstract

Computed tomography angiography (CTA) is widely used in preoperative evaluation of the lower limbs' vascular system for virtual surgical planning (VSP) of fibula free flap (FFF) for jaw reconstruction. The present retrospective clinical study analysed = 72 computed tomography angiographies (CTA) of lower limbs for virtual surgical planning (VSP) for jaw reconstruction. The purpose of the investigation was to evaluate the morphology of the fibular bone and its vascular supply in CTA imaging, and further, the amount and distribution of periosteal branches (PB) and septo-cutaneous perforators (SCPs) of the fibular artery. A total of 144 lower limbs was assessed (mean age: 58.5 ± 15.3 years; 28 females, 38.9%; 44 males, 61.1%). The vascular system was categorized as regular (type I-A to II-C) in 140 cases (97.2%) regarding the classification by Kim. Absent anterior tibial artery (type III-A, = 2) and posterior tibial artery (type III-B, = 2) were detected in the left leg. Stenoses were observed mostly in the fibular artery ( = 11), once in the anterior tibial artery, and twice in the posterior tibial artery. In total, = 361 periosteal branches (PBs) and = 231 septo-cutaneous perforators (SCPs) were recorded. While a distribution pattern for PBs was separated into two clusters, a more tripartite distribution pattern for SCPs was found. We conclude that conventional CTA for VSP of free fibula flap (FFF) is capable of imaging and distinguishing SCPs and PBs.

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References

Freeman G, HALTON J . Note on an exact treatment of contingency, goodness of fit and other problems of significance. Biometrika. 1951; 38(1-2):141-9. View

Masia J, Clavero J, Larranaga J, Alomar X, Pons G, Serret P . Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg. 2006; 59(6):594-9. DOI: 10.1016/j.bjps.2005.10.024. View

Goetze E, Kammerer P, Al-Nawas B, Moergel M . Integration of Perforator Vessels in CAD/CAM Free Fibula Graft Planning: A Clinical Feasibility Study. J Maxillofac Oral Surg. 2020; 19(1):61-66. PMC: 6954946. DOI: 10.1007/s12663-019-01215-y. View

Shwaiki O, Rashwan B, Fink M, Kirksey L, Gadani S, Karuppasamy K . Lower extremity CT angiography in peripheral arterial disease: from the established approach to evolving technical developments. Int J Cardiovasc Imaging. 2021; 37(10):3101-3114. DOI: 10.1007/s10554-021-02277-1. View

Colletti G, Autelitano L, Rabbiosi D, Biglioli F, Chiapasco M, Mandala M . Technical refinements in mandibular reconstruction with free fibula flaps: outcome-oriented retrospective review of 99 cases. Acta Otorhinolaryngol Ital. 2015; 34(5):342-8. PMC: 4299154. View

Abou-Foul A, Fasanmade A, Prabhu S, Borumandi F . Anatomy of the vasculature of the lower leg and harvest of a fibular flap: a systematic review. Br J Oral Maxillofac Surg. 2017; 55(9):904-910. DOI: 10.1016/j.bjoms.2017.08.363. View

Taylor G, Miller G, Ham F . The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975; 55(5):533-44. DOI: 10.1097/00006534-197505000-00002. View

Tarsitano A, Ciocca L, Cipriani R, Scotti R, Marchetti C . Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it. Acta Otorhinolaryngol Ital. 2015; 35(3):198-201. PMC: 4510936. View

Abdel Razek A, Denewer A, Hegazy M, Hafez M . Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction. Int J Oral Maxillofac Surg. 2014; 43(7):811-5. DOI: 10.1016/j.ijom.2014.03.014. View

10.

Wilde F, Winter K, Kletsch K, Lorenz K, Schramm A . Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods. Int J Comput Assist Radiol Surg. 2014; 10(2):129-40. DOI: 10.1007/s11548-014-1065-1. View

11.

Ngaage L, Hamed R, Oni G, Di Pace B, Ghorra D, Koo BMedSci B . The Role of CT Angiography in Assessing Deep Inferior Epigastric Perforator Flap Patency in Patients With Pre-existing Abdominal Scars. J Surg Res. 2019; 235:58-65. DOI: 10.1016/j.jss.2018.09.059. View

12.

Knitschke M, Backer C, Schmermund D, Bottger S, Streckbein P, Howaldt H . Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions. Cancers (Basel). 2021; 13(12). PMC: 8235255. DOI: 10.3390/cancers13123013. View

13.

Holzle F, Franz E, von Diepenbroick V, Wolff K . [Evaluation of the lower leg vessels before microsurgical fibula transfer. Magnetic resonance angiography versus digital subtraction angiography]. Mund Kiefer Gesichtschir. 2003; 7(4):246-53. DOI: 10.1007/s10006-003-0486-8. View

14.

Napoli A, Anzidei M, Zaccagna F, Cavallo Marincola B, Zini C, Brachetti G . Peripheral arterial occlusive disease: diagnostic performance and effect on therapeutic management of 64-section CT angiography. Radiology. 2011; 261(3):976-86. DOI: 10.1148/radiol.11103564. View

15.

Attia S, Wiltfang J, Streckbein P, Wilbrand J, Khassawna T, Mausbach K . Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants. J Craniomaxillofac Surg. 2019; 47(5):786-791. DOI: 10.1016/j.jcms.2018.12.017. View

16.

Kansy K, Mueller A, Mucke T, Kopp J, Koersgen F, Wolff K . Microsurgical reconstruction of the head and neck--current concepts of maxillofacial surgery in Europe. J Craniomaxillofac Surg. 2014; 42(8):1610-3. DOI: 10.1016/j.jcms.2014.04.030. View

17.

Mishra A, Jain N, Bhagwat A . CT Angiography of Peripheral Arterial Disease by 256-Slice Scanner: Accuracy, Advantages and Disadvantages Compared to Digital Subtraction Angiography. Vasc Endovascular Surg. 2017; 51(5):247-254. DOI: 10.1177/1538574417698906. View

18.

Sendeski M, Persson A, Liu Z, Busch J, Weikert S, Persson P . Iodinated contrast media cause endothelial damage leading to vasoconstriction of human and rat vasa recta. Am J Physiol Renal Physiol. 2012; 303(12):F1592-8. DOI: 10.1152/ajprenal.00471.2012. View

19.

Shroff S, Nair S, Shah A, Kumar B . Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study. J Maxillofac Oral Surg. 2017; 16(1):101-107. PMC: 5328874. DOI: 10.1007/s12663-016-0930-6. View

20.

Prokop M . Multislice CT angiography. Eur J Radiol. 2000; 36(2):86-96. DOI: 10.1016/s0720-048x(00)00271-0. View