Surgical Technique
July 2005

Use of Fibula-Free Tissue Transfer With Preoperative 2-Vessel Runoff to the Lower Extremity

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas; and Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth, Tex.

Correspondence: Yadranko Ducic, MD, FRCSC, Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, 1500 S Main St, Fort Worth, TX 76104 (


Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Facial Plast Surg. 2005;7(4):261-264. doi:10.1001/archfaci.7.4.261

Objective  To present our experience with fibula-free tissue transfer in patients with documented 2-vessel runoff to the lower extremity on preoperative angiography.

Methods  A case series of 16 patients with segmental mandibular defects reconstructed with a fibula-free flap by the senior author with 100% stenosis of the anterior or posterior tibial arteries were retrospectively reviewed for radiographic data and complications.

Results  All flaps performed were successful, and there were no donor site complications. Angiography documented flow of contrast to the foot by a patent anterior or posterior tibial artery in all patients. Occlusive arteriosclerotic disease was identified in the anterior tibial artery in 10 patients and in the posterior tibial artery in 6 patients.

Conclusions  Using our specific criteria, we experienced no complications with the use of a fibula-free flap in extremities with 100% obstructive vascular disease in the anterior or posterior tibial artery. Preoperative angiography is indicated to select appropriate candidates for fibula-free tissue transfer with 2-vessel lower extremity runoff to avoid potential donor site ischemic complications.