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Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis
Jannik Ketschau1, Jonathan Mohr1, Yannik Leonhardt2
1Department of Oral and Maxillofacial Surgery, TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany.
Microsurgery
|July 15, 2026
Summary
Accurate fibula free flap planning requires understanding septocutaneous fibular artery perforators. Artery-based mapping is more stable than fibula-based mapping for perforator location, especially with fibular artery stenosis.
Area of Science:
- Vascular anatomy
- Microsurgery
- Reconstructive surgery
Background:
- Septocutaneous fibular artery perforator localization is critical for fibula free flap design.
- Lower-leg vascular anatomy's impact on perforator distribution is not well understood.
Purpose of the Study:
- To analyze perforator number and spatial distribution using computed tomography angiography (CTA).
- To compare fibula-based and artery-based reference systems for perforator mapping.
Main Methods:
- Retrospective analysis of lower-extremity CTA scans from 247 patients.
- Assessment of perforator number and position using fibula- and artery-based systems.
- Evaluation of associations with vascular parameters like stenosis and run-off status.
Main Results:
- 812 septocutaneous perforators were identified across 491 limbs.
- Fibular artery stenosis correlated with fewer perforators (p < 0.001).
- Perforator distribution varied by reference system; artery-based mapping showed greater stability.
Conclusions:
- Septocutaneous perforator spatial distribution is reference-dependent.
- Fibular artery stenosis reduces perforator count; artery-based mapping is recommended for fibula flap planning.
