Value of routine angiography before traumatic lower-limb reconstruction with microvascular free tissue transplantation

From November 1993 to June 1997, long-bone defects in 40 trauma patients were reconstructed with free osteoseptocutaneous fibula flaps. To determine the necessity of routine angiography in traumatized lower limbs before free flap transplantation, a prospective study was carried out. The study subjects were 34 patients, 25 males and 9 females, with an average age of 40.6 years. Reconstruction was performed primary for bone defects after Gustillo type III b open fractures in 17 patients and secondarily for malunion and osteomyelitis in 17 patients. Reconstructed bone defects included 25 tibias and 9 femurs. Normal pedal pulses were palpable in 31 patients. Angiographic findings were abnormal in seven patients. In the three patients with abnormal pedal pulses, the particular nonpalpable pulses correlated with the vascular lesions shown in the angiograms (one in the tibial anterior artery and two in the tibial posterior artery). Four patients with either injury of the peroneal artery (three cases) or pseudoaneurysm of the tibial anterior artery (one case) had normal pedal pulses. In all patients, microvascular transplantations were performed successfully. Our study demonstrates the importance of thorough clinical evaluation. Preoperative angiography of the injured lower limbs did not provide relevant additional informations in this series. Familiarity with all available techniques makes it possible to cope with almost any difficult posttraumatic vascular condition. Routine recipient-site angiography before microsurgical reconstruction, therefore, seems unjustified.