Among arterial anatomic conditions which will adversely affect the har
vest of the fibula are 1) significant arteriosclerotic disease within
the tibial-peroneal vessels; 2) peroneal arteria magna (PAM), a condit
ion in which only the peroneal artery supplies the foot; and 3) absenc
e of the peroneal artery, either congenitally or as an acquired defect
. in each of these anatomic conditions, removal of the peroneal vessel
s and the fibula free flap will jeopardize either the donor leg, the f
ibula flap, or both. All patients considered for fibula flaps were eva
luated with preoperative leg angiograms. In 28 consecutive patients ev
aluated with angiography for planned free-fibula flap reconstructions,
23 actually underwent free-fibula harvest. Angiographic abnormalities
that altered the operative plan were found in seven (25 percent) pati
ents. Four of the seven patients had vascular examinations prior to su
rgery with abnormal findings. Three of the seven (11 percent) patients
with abnormal arterial anatomy had normal vascular examinations prior
to surgery. Thus, if a preoperative angiogram had not routinely been
done, the abnormal anatomy would not have been discovered until surger
y. This could have resulted in an unusable flap in one patient, and an
ischemic or gangrenous foot in two other patients. With this angiogra
phic guidance, there were no vascular complications from harvest of th
e fibula. The routine use of preoperative bilateral leg angiography is
recommended, or an alternative method of vessel imaging, in all patie
nts evaluated for microvascular free-tissue transfer of the fibula.