Clinical impact of magnetic resonance angiography in patients undergoing free fibular flap transfer

Abstract Objective This retrospective study was carried out to assess the impact of dynamic time‐resolved magnetic resonance angiography (DTR‐MRA) in detecting lower extremity vascular abnormalities and its impact on deciding the harvest site in patients undergoing free fibular transfer. Methods Consecutive patients who underwent DTR‐MRA imaging of lower extremities prior to free fibular flap transfer (FFFT) during the period of 2008–2020 were retrospectively included in the study. Retrospective review of medical records was performed to include the patients who had provisional side of harvest decided prior to DTR‐MRA based on clinical findings. The criteria for change in management included changing the harvest site, either to the contralateral leg or a different site based on DTR‐MRA. Results Imaging findings in 103 patients who underwent DTR‐MRA prior to FFFT were included in the study. Overall incidence of vascular abnormalities of clinical significance for FFFT was 30/103 (29%), and site of harvest was changed in 30/103 (29%) patients after DTR‐MRA study. Addition of delayed venous phase imaging detected additional venous pathologies of clinical significance in 7/103 (6.8%) patients. Conclusions DTR‐MRA as a preoperative study before FFFT has an excellent accuracy in detecting vascular abnormalities of clinical significance. Addition of delayed phase images can also detect clinically significant venous abnormalities.