The use of nuclear bone scanning after fibula free tissue transfer

Authors

  • Maxwell C. Furr MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
    • Send correspondence to Maxwell C. Furr, MD, Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, PV-01, Portland, OR 97239. E-mail: furrm@ohsu.edu

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  • Steven Cannady MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Robert Nance MD,

    1. Department of Radiology, Division of Nuclear Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Mark K. Wax MD, FRCS

    1. Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Abstract presented at the American Academy of Otolaryngology Annual Meeting, San Diego, California, U.S.A., October 5, 2009.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To understand the role of nuclear bone scanning in the evaluation of threatened osteocutaneous free tissue transfers, identify patients who may benefit from nuclear bone scanning after head and neck reconstructive surgery, and be able to use nuclear bone scanning to help guide management of the threatened free flap.

Study Design

Retrospective case series design set in a tertiary referral center.

Methods

Records of patients undergoing bone scan in the context of threatened osteocutaneous free tissue transfer between July 1998 and December 2008 were reviewed.

Results

Over a 10-year period, 205 fibula free tissue transfers were performed, with an overall 94% success rate. Fifteen fibular free flaps in 14 patients were determined to be threatened in the late postoperative period, and nuclear bone scanning was performed. Seven of 15 flaps had regions of certain flap nonviability, with five flaps clearly appearing viable on bone scanning. No graft read as potentially viable eventually failed. All grafts read as nonviable underwent exploration and debridement, with confirmation of nonviability in all cases. In eight cases, bone scanning allowed preoperative planning for soft tissue flap reconstruction.

Conclusions

In those instances in which the skin paddle dies in the late postoperative period and determination of bone viability is required, a bone scan can demonstrate whether or not the bone is alive. This information can help determine the future operative and reconstructive options available for the patient.

Level of Evidence: 4. Laryngoscope, 123:2980–2985, 2013

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