Fibula free flaps: The role of angiography in patients with abnormal results on preoperative color flow Doppler studies

Background: The reliability of normal color flow Doppler (CFD) study results in predicting the safety of fibula free flap harvest has been recognized. The significance of abnormal CFD study results when used for preoperative assessment of a potential fibula free flap donor site is less well defined. Objective: To determine if abnormal preoperative CFD study results should exclude fibula free flap harvest or if patients, in whom the fibula free flap is thought to be the best reconstructive option, should undergo further evaluation with angiography to better determine fibula free flap candidacy. Methods: A retrospective review identified 17 potential fibula free flap candidates (34 legs) evaluated by both a lower extremity CFD study and a lower extremity angiogram. The results of the CFD study were then compared with those of angiography. Results: There were 16 legs with normal CFD study results and subsequent angiographic findings confirming the safety of each of these legs for fibula free flap harvest. There were 18 legs that demonstrated abnormal CFD study results. Angiography revealed anatomy that was considered to represent a high risk for fibula free flap harvest in 16 legs and considered safe in the other 2 legs. All 14 legs that had at least 1 vessel with a monophasic waveform or no flow on the CFD study revealed a high-risk angiogram result. Of the 4 legs with biphasic waveforms in all trifurcation vessels on the CFD study, 2 revealed angiogram results that showed that they were safe for flap harvest. Conclusions: Preoperative CFD studies that reveal a monophasic waveform or absence of flow accurately identify unsafe donor sites. Fibula free flap harvest in these cases can be excluded based on abnormal CFD study results alone, eliminating the need to perform angiography.