Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.
J, K., J, M., Y, L., A, G., H, S., H, K., N, K., S, H., K, P., & H, S. (2026). Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.. Microsurgery. https://doi.org/10.1002/micr.70266
J K, J M, Y L, A G, H S, H K, et al. Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.. Microsurgery. 2026; doi: 10.1002/micr.70266
J K, J M, Y L, et al. Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.[J]. Microsurgery. 2026. DOI: 10.1002/micr.70266.
@article{j2026,
author = {Ketschau J and Mohr J and Leonhardt Y and Grabenhorst A and Singer H and Kram H and Krautkremer N and Heimüller S and Pippich K and Stimmer H},
title = {Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.},
journal = {Microsurgery},
year = {2026},
doi = {10.1002/micr.70266},
note = {PMID: 42452877},
}
TY - JOUR AU - Ketschau J AU - Mohr J AU - Leonhardt Y AU - Grabenhorst A AU - Singer H AU - Kram H AU - Krautkremer N AU - Heimüller S AU - Pippich K AU - Stimmer H TI - Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis. T2 - Microsurgery PY - 2026 DO - 10.1002/micr.70266 AN - PMID:42452877 ER -
BACKGROUND: Reliable localization of septocutaneous fibular artery perforators is essential for fibula free flap planning. However, the influence of lower-leg vascular anatomy on perforator number and spatial distribution remains unclear. This study aimed to analyze perforator number and spatial distribution using computed tomography angiography (CTA) with both fibula- and artery-based reference systems. METHODS: In this retrospective study, patients undergoing lower-extremity CTA before mandibular continuity resection were screened. Parameters included run-off status, Kim classification, vascular anomalies, atherosclerotic plaque, and morphometric characteristics of the fibula and fibular artery. Perforator number per limb and relative perforator position were assessed using fibula- and artery-based reference systems. Associations were evaluated using nonparametric tests and multivariable regression models. RESULTS: A total of 491 limbs from 247 patients were included, yielding 812 septocutaneous perforators. Limbs with fibular artery stenosis showed fewer perforators compared with limbs without stenosis (median 0.5 [0-2] vs. 2 [1-2], p < 0.001). Perforator distribution was nonuniform in both reference systems, with clustering in mid-segments (p < 0.001). Notably, spatial distribution patterns differed depending on the reference system used. In multivariable analyses, non-1A Kim run-off classification was associated with a more proximal perforator position along the fibula (β = -10.0 percentage points, p < 0.001), whereas no limb-level factor was associated with artery-referenced perforator position, indicating greater stability of artery-based mapping. CONCLUSION: Septocutaneous fibular artery perforators show reference-dependent spatial variability. Fibular artery stenosis is associated with fewer perforators, whereas only Kim run-off classification affects fibula-referenced location. These findings support artery-based mapping for fibula flap planning.