Posterior tibial artety abnormality and the role of CT-angiography in planning free flap transfer for management of chronic osteomyelitis of tibia: case report
Abstract
The authors describe the course of treatment of a 43-year-old patient with a fracture of the tibia complicated by osteomyelitis. Radical interdisciplinary treatment consisted in an extensive debridement of soft tissues and skeleton and subsequent coverage of the defect by the gracilis free flap transfer.
Preoperative CT-angiography was not indicated as pulsation of the posterior tibial artery behind the medial malleolus was palpable and the Doppler ultrasound examination confirmed the presence of a good quality artery. However, during operation, an unfilled and stenosed artery was found in the area planned for anastomosis that made this procedure impossible.
Exposure of the artery distal to the stenosis in the region behind the medial malleolus confirmed blood backflow. Thus as the recipient artery it was possible to use only the posterior tibial artery proximal to the stenosis in the region of the first acceptable muscle perforator, about 10 cm above the site originally planned for anastomosis.
The study specifies the procedure for management of such condition, allowing to perform a free tissue transfer and to use the originally planned recipient vessels of the posterior tibial artery bundle and the gracilis free flap transfer. Despite the described intraoperative complication, the authors conclude that CT-angiography should not be always a part of the routine examination in planning a free flap transfer on the lower extremity and should be indicated only in specified cases.