[The peroneal or fibular free flaps. Surgical anatomy, operative procedures and indications]

The microsurgical story of the fibula began 25 years ago. The author reports on the vascular anatomy of the fibular free flaps, particularly the osseous, cutaneous and muscular branches of the fibular artery and their variations. This surgical anatomy explains the various osseous and composite flaps that can be harvested on the fibular vessels. The fibular flaps harvested on the anterior tibial vessels are used less often. The surgical procedure is explained about the typical osteocutaneous peroneal flap and the many other variations. The indications and results are discussed according to the international literature and the author's experience: 42 mandibular, 12 tibial, ten femoral, three radial, two humeral and one nasomaxillary reconstructions. The aetiological and topographical particularities, various abilities of the fibular donor site, preoperative strategy, bone implantation and contention, vascular anastomosis and delays of consolidation are analysed for each recipient site. The advantages and disadvantages of these fibular flaps are then discussed. Finally, the present and future associated procedures are evoked.