Objectives:

Fibula free flap (FFF) surgery complications can arise from vascular disease within the donor peroneal artery.1-4

Computed Tomography Angiography (CTA) has become standard for preoperative evaluation.5,6

We aim to improve preoperative FFF risk evaluation by implementing two complementary quantitative scoring systems: The Bollinger Score and Lower Limb Arterial Calcification Score.7,10

Methodology:

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 complicationswithin 90 days.

Peroneal Bollinger and crural segment LLAC scores were calculated from routine preoperative CTAs.

Results: 

There were no statistically significant differences in baseline demographics or clinical characteristics between those who experienced complications and those who did not.

Higher BS were significantly associated with increased risk of complications and longer hospital stays.

A Bollinger Score above 0.5 was significantly associated with nearly 4 times higher odds of complications.

Patient with both scores above cutoff values had over an 8-fold increase in the odds of complications.

Conlusions:

Preoperative vascular assessment of donor vessels is critical for optimizing free flap survival and minimizing postoperative complications.

This study is the first to explore the utility of quantitative preoperative risk assessment in FFF surgery.

Our findings suggest that quantitative assessment of the peroneal vessel can improve risk stratification for patients undergoing fibula free flap surgery.

These scoring systems offer an objective framework that may enhance patient selection and guide strategies to reduce postoperative complications.

Notably, integrating multiple vascular scoring systems may offer a more comprehensive and reliable approach to preoperative decision-making.

Combining scores may enhance risk stratification and help identify patients who would benefit from modified surgical planning or additional preoperative optimization.