Bone Scintigraphy in the Postoperative Assessment of Fibula Free Flaps in Head and Neck Surgery: A Retrospective Review

Background and Objectives: This study evaluated bone scintigraphy as a postoperative monitoring tool for assessing the viability of fibula free flaps (FFFs) in the early postoperative period. Methods: This monocentric, retrospective study was conducted at a tertiary care center in India. Medical records of patients who underwent postoperative bone scintigraphy following FFF reconstruction between January 2008 and December 2024 were reviewed. Results: A total of 79 FFF procedures were performed during the study period, of which 56 patients met the inclusion criteria. The overall flap success rate was 94.64%. Clinically suspected flap compromise was observed in six patients. Among these, three patients demonstrated viable tracer uptake on bone scintigraphy and subsequently developed only partial flap failure, allowing conservative management without unnecessary flap exploration. Total flap failure occurred in three patients, two of whom demonstrated ischaemic tracer activity on bone scintigraphy, which correlated with intraoperative confirmation of flap nonviability ( P = 0.019). Bone scintigraphy demonstrated a sensitivity of 94.3% and specificity of 64% for detecting flap compromise. Conclusions: Bone scintigraphy is a useful adjunct in monitoring FFFs, particularly in late-threatened flaps and may assist decision-making regarding conservative management and timely surgical intervention.