{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:46:12Z","timestamp":1791902772413,"version":"4.3.4"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Preoperative computed tomography angiography (CTA) of the lower extremities is commonly performed before fibula free flap (FFF) harvest for mandibular reconstruction. While CTA is intended to improve harvest side safety, its actual impact on reconstructive decision-making and postoperative outcomes remains insufficiently characterized.<\/jats:p>\n                  <jats:p>In this retrospective, single-center cohort study, patients undergoing mandibular continuity resection between July 2012 and June 2023 who received preoperative lower extremity CTA were analyzed. CTA-derived vascular parameters, including plaque presence, three-vessel run-off, and a bilateral vascular anomaly score, were systematically assessed. Associations with fibula flap selection (yes\/no) and postoperative outcomes were analyzed using logistic regression and non-parametric statistical methods. Discriminatory performance was evaluated by receiver operating characteristic (ROC) analysis, including a combined CTA-based multivariable model.<\/jats:p>\n                  <jats:p>A total of 247 patients were included. CTA-derived parameters were strongly associated with the decision to perform a reconstruction with FFF, but showed no consistent association with postoperative outcomes such as revision surgery, flap loss, or length of hospitalization. After directional alignment of predictors, ROC analysis demonstrated moderate to good discrimination for individual parameters, including absence of plaque on any side (area under the ROC curve [AUC] 0.745) and the inverted bilateral vascular anomaly score (AUC 0.686). A combined multivariable CTA-based model integrating all vascular parameters achieved excellent discrimination for FFF selection (AUC 0.826). None of the CTA-derived variables independently predicted postoperative complications. Notably, FFF reconstruction was also performed in a small subset of patients despite the absence of three-vessel run-off, without an apparent increase in postoperative complications.<\/jats:p>\n                  <jats:p>Lower extremity CTA primarily serves as a preoperative decision-support tool guiding FFF selection rather than as a predictor of postoperative outcomes. CTA-based vascular assessment enables effective upstream risk stratification and supports individualized reconstructive planning in mandibular reconstruction.<\/jats:p>","DOI":"10.1055\/a-2886-9931","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:58:42Z","timestamp":1780527522000},"source":"Crossref","is-referenced-by-count":2,"title":["The Role of Preoperative Lower Extremity CT Angiography in Mandible Reconstruction: A Retrospective Cohort Analysis"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2518-4583","authenticated-orcid":false,"given":"Jonathan","family":"Mohr","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5520-4635","authenticated-orcid":false,"given":"Jannik","family":"Ketschau","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannik","family":"Leonhardt","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Germany","place":["Bavaria"],"department":["Institute of Diagnostic and Interventional Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Grabenhorst","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Singer","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Kram","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Krautkremer","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Pippich","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Dietrich","family":"Wolff","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-0344","authenticated-orcid":false,"given":"Lucas M.","family":"Ritschl","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"issue":"13","key":"ref1","doi-asserted-by":"crossref","first-page":"11093","DOI":"10.1007\/s00432-023-04963-0","article-title":"Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: Is tumorous bone infiltration or location and resulting soft tissue recurrences a long-term problem?","volume":"149","author":"L M Ritschl","year":"2023","journal-title":"J Cancer Res Clin Oncol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1002\/ca.22019","article-title":"Oromandibular 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A prospective blinded comparison between magnetic resonance angiography and digital subtraction angiography","volume":"33","author":"S Klein","year":"2013","journal-title":"Microsurgery"},{"issue":"12","key":"ref19","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1177\/0284185120980001","article-title":"Standardize routine angiography assessment of leg vasculatures before fibular flap harvest: Lessons of congenital and acquired vascular anomalies undetected by color Doppler and physical examinations","volume":"62","author":"C Ma","year":"2021","journal-title":"Acta Radiol"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/s12663-020-01483-z","article-title":"Analysis of variation in anatomy of lower limb vasculature and implications for free fibula flap by color Doppler imaging","volume":"21","author":"D Sunnysinh","year":"2022","journal-title":"J Maxillofac Oral 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Ahn","year":"2024","journal-title":"Microsurgery"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/00001665-200111000-00021","article-title":"Donor site angiography before mandibular reconstruction with fibula free flap","volume":"12","author":"L Seres","year":"2001","journal-title":"J Craniofac Surg"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"541e","DOI":"10.1097\/PRS.0b013e318262f115","article-title":"A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteocutaneous flaps for head and neck reconstruction","volume":"130","author":"P B Garvey","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/ans.13274","article-title":"Mandibular reconstruction: Meta-analysis of iliac- versus fibula-free flaps","volume":"86","author":"S Lonie","year":"2016","journal-title":"ANZ J 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Otolaryngol"},{"issue":"10","key":"ref30","doi-asserted-by":"crossref","first-page":"e0257457","DOI":"10.1371\/journal.pone.0257457","article-title":"Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis","volume":"16","author":"M A Mashrah","year":"2021","journal-title":"PLoS ONE"},{"issue":"09","key":"ref31","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jcms.2016.04.029","article-title":"Predictors of free flap loss in the head and neck region: A four-year retrospective study with 451 microvascular transplants at a single centre","volume":"44","author":"T M\u00fccke","year":"2016","journal-title":"J Craniomaxillofac Surg"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/00000637-199906000-00014","article-title":"Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction","volume":"42","author":"M Deutsch","year":"1999","journal-title":"Ann Plast Surg"},{"issue":"07","key":"ref33","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.ijom.2014.03.014","article-title":"Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction","volume":"43","author":"A A Abdel Razek","year":"2014","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1002\/jso.24976","article-title":"Early and late complications in the reconstructed mandible with free fibula flaps","volume":"117","author":"J TM van Gemert","year":"2018","journal-title":"J Surg Oncol"}],"container-title":["Journal of Reconstructive 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