Clinical information regarding the fibula flap gained from digital subtraction angiography useful for flap elevation

The fibula free flap (FFF) is commonly used in mandible reconstruction due to its good bone length and volume, and availability of a long vascular pedicle - the fibular artery (FA). In this study, digital subtraction angiography (DSA) was utilized to evaluate the lower leg arteries in 130 patients (48 female, 82 male). The mean distance from the fibula head to the fibular artery (FA) origin was 72.8 mm, with significant differences between sexes (P=0.019) and sides in males (P=0.033). FA diameters were significantly larger in males (P=0.042); in females, right-side FA diameters were larger than left (P=0.002). While stenosis grades varied significantly by side for popliteal and tibial arteries, the FA remained consistent. However, females showed higher popliteal stenosis (P=0.028). Notably, the FA was the primary foot supply in 20% of cases (24.0% females, 17.7% males). DSA provides valuable information for preoperative planning and for safe and effective FFF transfer. This study adds to our understanding of the lower leg vessel anatomy, supporting surgeons in selecting the most suitable flap.