The use of nuclear bone scanning after fibula free tissue transfer

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.