The congenital popliteal vasculature patterns in fibular free flap reconstruction by means of surgical anatomy in cadavers

Abstract

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone. Thus, understanding its vasculature variation is crucial. This study investigates the popliteal artery branching variations in Thai cadavers and compares them with previous studies. One hundred and sixty-two legs from 81 formalin-embalmed cadavers were dissected. The popliteal artery branching patterns were classified. The previous data retrieved from cadaveric and angiographic studies were also collected and compared with the current study. The most common pattern is type I-A (90.7%). For the variants, type III-A was the majority among variants (6.2%). Type IV-A, hypoplastic peroneal artery, was found in one limb. A symmetrical branching pattern was found in 74 cadavers. Compared with cadaveric studies, type III-B and III-C are significantly common in angiographic studies (p = 0.015 and p = 0.009, respectively). Type I-A is most common according to previous studies. Apart from this, the prevalence of type III-A variant was higher than in previous studies. Furthermore, type III-B and III-C are more frequent in angiographic studies which might be from atherosclerosis. Thus, if the pre-operative CTA policy is not mandatory, the patients at risk for atherosclerosis and population with high variants prevalence should undergo pre-operative CTA with cost-effectiveness consideration.

The Versatility of Atherosclerotic Cardiovascular Disease Risk Score in Determination of Popliteal Artery Branches Patency in Computed Tomography Angiography

“…If this were found to be true, the ASCVD risk scores could benefit preoperative decision-making in different clinical practice settings, such as vascular bypass procedures; intravascular surgery; reconstruction requiring donor site from lower extremity, such as fibular free flap (FFF); anterolateral thigh (ALT) flap, and wound healing regarding arterial insufficiency. [4][5][6]10,[14][15][16][17] The lifetime ASCVD risk scores for the popliteal artery and all of its branches were significantly lower in the nonstenosis group than in the stenosis group (P < 0.05). Accordingly, the 10-year ASCVD risk scores of all evaluated arteries, except the peroneal artery, were significantly lower in the nonstenosis group than in the stenosis group (P < 0.01).…”

“…This finding supports the hypothesis that the peroneal artery is less likely to be affected by atherosclerosis according to previous study. 5 The factors reported to influence this hypothesis include the amount of muscle supply, the blood flow pattern, and local vessel-related factors. 5 , 8 , 21 …”

“… 5 The factors reported to influence this hypothesis include the amount of muscle supply, the blood flow pattern, and local vessel-related factors. 5 , 8 , 21 …”

“…PAD can lead to stenotic or occluded arteries of the legs, including the popliteal artery, anterior tibial artery, posterior tibial artery, and peroneal artery. 5 – 7 …”

“…However, no recommendation/guideline that is specific to preoperative CTA of the lower extremities prior to FFF harvest has been established. 5 Furthermore, the risk of contrast-induced nephropathy (CIN) in chronic kidney disease patients is an important consideration before ordering CTA of the lower extremities. The atherosclerotic cardiovascular disease (ASCVD) risk score was established to estimate an individual’s risk of developing CAD, and it has been widely used and accepted in clinical practice.…”