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Lebenatus A, Tesch K, Rudolph W, Naujokat H, Koktzoglou I, Edelman RR, Graessner J, Jansen O, Salehi Ravesh M. Evaluation of Lower Leg Arteries and Fibular Perforators before Microsurgical Fibular Transfer Using Noncontrast-Enhanced Quiescent-Interval Slice-Selective (QISS) Magnetic Resonance Angiography. J Clin Med 2023; 12:1634. [PMID: 36836170 PMCID: PMC9964888 DOI: 10.3390/jcm12041634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Preoperative imaging of the lower leg arteries is essential for planning fibular grafting. The aim of this study was to evaluate the feasibility and clinical value of non-contrast-enhanced (CE) Quiescent-Interval Slice-Selective (QISS)-magnetic resonance angiography (MRA) for reliably visualizing the anatomy and patency of the lower leg arteries and for preoperatively determining the presence, number, and location of fibular perforators. (2) Methods: The anatomy and stenoses of the lower leg arteries and the presence, number, and location of fibular perforators were determined in fifty patients with oral and maxillofacial tumors. Postoperative outcomes of patients after fibula grafting were correlated with preoperative imaging, demographic, and clinical parameters. (3) Results: A regular three-vessel supply was present in 87% of the 100 legs. QISS-MRA was able to accurately assign the branching pattern in patients with aberrant anatomy. Fibular perforators were found in 87% of legs. More than 94% of the lower leg arteries had no relevant stenoses. Fibular grafting was performed in 50% of patients with a 92% success rate. (4) Conclusions: QISS-MRA has the potential to be used as a preoperative non-CE MRA technique for the diagnosis and detection of anatomic variants of lower leg arteries and their pathologies, as well as for the assessment of fibular perforators.
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Affiliation(s)
- Annett Lebenatus
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Karolin Tesch
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Wiebke Rudolph
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Arayapithak K, Suwannanon R, Hongsakul K. Popliteal artery branching variations on computed tomography angiography of 1542 lower limbs and its associated factors. Acta Radiol 2023; 64:874-880. [PMID: 35350850 DOI: 10.1177/02841851221088801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The identification of popliteal artery branching variation is of anatomical importance for surgical and endovascular procedures in the posterior region of the knee and below. PURPOSE To evaluate the variations and associated factors of popliteal artery branching by computed tomography angiography (CTA). MATERIAL AND METHODS CTA of the lower extremities of 1542 lower limbs in 771 patients (513 men and 258 women) were retrospectively reviewed to assess the popliteal artery branching patterns. The patient's sex, side of lower limbs, and population were recorded and evaluated for their association with popliteal artery branching patterns. P < 0.05 was considered to indicate statistical significance. RESULTS Variations in the branching of the popliteal artery were recorded in 9.3% of patients. The three most common variations were found to be hypoplastic-aplastic posterior tibial artery (PT) (3.6%), trifurcation (2.0%), and hypoplastic-aplastic anterior tibial artery (0.8%). A new pattern was detected in 2 (0.1%) cases, which were described as double PTs. Statistically significant differences were noted in the proportion of variation branching between the male and female groups (odds ratio = 1.52; 95% confidence interval = 1.07-2.16; P = 0.02). CONCLUSION The findings on popliteal variational branching patterns in the present study were in conformance to previous reports. Our study identified a novel variation of popliteal artery branching, which has not been mentioned in the literature so far. Sex was found to be an associated factor of branching variation.
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Affiliation(s)
- Karakkada Arayapithak
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ruedeekorn Suwannanon
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, 37689Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Knitschke M, Baumgart AK, Bäcker C, Adelung C, Roller F, Schmermund D, Böttger S, Streckbein P, Howaldt HP, Attia S. Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning. Front Oncol 2022; 11:821851. [PMID: 35127535 PMCID: PMC8807634 DOI: 10.3389/fonc.2021.821851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success. METHOD This retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply. RESULT A total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs' vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP. CONCLUSION In general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.
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Affiliation(s)
- Michael Knitschke
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Anna Katrin Baumgart
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Christina Bäcker
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Christian Adelung
- Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Justus-Liebig-University, Giessen, Germany
| | - Fritz Roller
- Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Justus-Liebig-University, Giessen, Germany
| | - Daniel Schmermund
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Sebastian Böttger
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Philipp Streckbein
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
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Knitschke M, Baumgart AK, Bäcker C, Adelung C, Roller F, Schmermund D, Böttger S, Howaldt HP, Attia S. Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture. Diagnostics (Basel) 2021; 11:1865. [PMID: 34679563 PMCID: PMC8534841 DOI: 10.3390/diagnostics11101865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
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 n = 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, n = 2) and posterior tibial artery (type III-B, n = 2) were detected in the left leg. Stenoses were observed mostly in the fibular artery (n = 11), once in the anterior tibial artery, and twice in the posterior tibial artery. In total, n = 361 periosteal branches (PBs) and n = 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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Affiliation(s)
- Michael Knitschke
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Anna Katrin Baumgart
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Christina Bäcker
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Christian Adelung
- Department of Radiology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (C.A.); (F.R.)
| | - Fritz Roller
- Department of Radiology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (C.A.); (F.R.)
| | - Daniel Schmermund
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Sebastian Böttger
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
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