Clinical outcomes following intraoperative pedicle disruption in fibula free flaps

Jonathan Jelmini, Allison A. Slijepcevic, Urjeet Patel, Larissa Sweeny, Patrik Pipkorn, Yadro Ducic, Justine Moe, Amy Pittman, Karthik Rajasekaran, Jason Diaz, Carissa Thomas, Patrick Byrne, Jason Rich, Akina Tamaki, Liana Puscas, Daniel Petrisor, Mark K. Wax

Research output: Contribution to journalArticlepeer-review


Objectives: Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of the peroneal vessels. Methods: Multi-institutional retrospective chart review from 2000 to 2020. Results: Of 2975 harvested fibula free flaps, 26 had a history of pedicle severance during surgical reconstruction. Reasons for intraoperative pedicle severance included transection during muscular dissection 10/26 (39%), accidental severance with the bone saw 12/26 (46%), and other 4/26 (15.6%). The surgeon responsible for pedicle severance included residents 5/26 (19%), fellows 10/26 (39%), attendings 10/26 (39%), and unknown 1/26 (3.9%). The pedicle artery and vein were severed 10/26 (39%), artery 8/26 (31%), and vein 8/26 (31%). Truncated pedicle vessels were used 3/26 (11.7%), intraoperative anastomoses were performed 23/26 (89%). Postoperative revision in the OR within 7 days of surgery was required 6/26 (23%); 4 flaps were salvaged and 2 flaps failed, both arterial thrombosis. Flap failure was attributed to vascular thrombosis. Long-term flap survival and successful reconstructions were reported 24/26 (92%). Conclusion: Accidental severance of fibula free flap pedicle vessels can be corrected with intraoperative repair, without affecting long-term flap survival or reconstructive outcomes. Protecting the flap vessels while using the bone saw and during intramuscular dissection prevents accidental severance.

Original languageEnglish
Pages (from-to)1975-1978
Number of pages4
JournalHead and Neck
Issue number8
StatePublished - Aug 2023


  • compromise
  • fibula
  • free flap
  • pedicle
  • vascular injury


Dive into the research topics of 'Clinical outcomes following intraoperative pedicle disruption in fibula free flaps'. Together they form a unique fingerprint.

Cite this