Abstract
Background
Fibula free flap (FFF) surgery complications can arise from vascular disease within
the donor peroneal artery. Computed tomography angiography (CTA) has become standard
for preoperative evaluation. However, current methods rely on qualitative assessments
to determine surgical eligibility. This study aims to improve preoperative risk evaluation
by implementing two quantitative scoring systems, the Bollinger score and the lower
limb arterial calcification score (LLACS), assessing distinct vascular health components.
The Bollinger score quantifies intraluminal stenosis caused by atherosclerotic plaques,
while the LLACS quantifies arteriosclerosis by evaluating calcification within the
arterial walls.
Methods
A retrospective review was conducted on all head and neck microvascular FFF procedures
performed at a university-affiliated tertiary care center between August 2021 and
March 2023. Data collected included patient demographics, medical history, operative
details, and postoperative complications (infection, hematoma, seroma, fistula, dehiscence,
or flap failure) within 90 days. Peroneal artery Bollinger scores and crural segment
LLACSs from the donor lower extremity were calculated from preoperative CTAs.
Results
A total of 117 patients were included. Increasing Bollinger scores were significantly
associated with an increased risk of complications and longer hospital stays, even
after controlling for potential confounders. Combining both scores improved risk stratification,
with high-risk patients experiencing an 8.36-fold higher risk of complications.
Conclusion
Our findings suggest that quantitative preoperative peroneal vessel assessment improves
risk stratification for patients undergoing FFF surgery. These scoring systems may
enhance patient selection and guide strategies to minimize postoperative complications.
Integrating multiple scoring systems is key to the comprehensive assessment of vascular
health.
Keywords
fibula free flap - quantitative - Bollinger score - calcium score - risk stratification
- peroneal vessel
