Preoperative High-Resolution Ultrasound-Guided Design of the Fibula Osteoseptocutaneous Flap: A Structured Surgeon-Performed Protocol
- 1Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
- 2Plastic and Reconstructive Surgery, Department of Medical Area (DMED), University Hospital Santa Maria della Misericordia of Udine, University of Udine, 33100 Udine, Italy
- 3Unit of Vascular Surgery, United Hospitals Villa Sofia-Cervello, 90146 Palermo, Italy
Abstract
Background/Objectives: The fibula osteoseptocutaneous flap is an established option for head and neck reconstruction. Preoperative planning requires assessment of donor-limb arterial anatomy and localization of cutaneous perforators. This study describes a structured surgeon-performed Conventional High-Frequency Ultrasound (CHFUS) protocol and evaluates its correlation with intraoperative findings. Methods: This retrospective study included patients undergoing reconstruction with a fibula osteoseptocutaneous free flap between January 2024 and December 2025. A standardized two-phase CHFUS workflow was used to assess infrapopliteal arterial anatomy and identify, characterize, and mark perforators at their deep fascial emergence. Preoperative findings were compared with intraoperative anatomy. Results: Ten patients underwent fibula flap reconstruction. Eighteen perforators were mapped, with a mean of 1.80 ± 0.63 per patient. The most common Kim–Lippert vascular pattern was type I (90%). Mean peroneal artery diameter at its origin was 2.83 ± 0.15 mm, and mean dominant perforator diameter at deep fascial emergence was 1.04 ± 0.14 mm. All 10 patients met the predefined anatomical agreement threshold of ≤1 cm (100%; exact two-sided 95% confidence interval, 69.2–100%). No flap required intraoperative redesign because of perforator anatomy. All flaps survived, without partial skin-paddle necrosis, donor-site ischemia, or vascular complications. Conclusions: This structured surgeon-performed CHFUS protocol was feasible and useful for fibula osteoseptocutaneous flap planning, enabling assessment of arterial anatomy, reliable perforator localization, and translation of preoperative findings into skin-paddle design. CHFUS should be considered complementary to CT angiography. Larger prospective studies are required to evaluate interoperator reproducibility and the diagnostic performance of CHFUS for clinically relevant arterial variants.
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BibTeX
@article{dente2026preoperative,
title = {{Preoperative High-Resolution Ultrasound-Guided Design of the Fibula Osteoseptocutaneous Flap: A Structured Surgeon-Performed Protocol}},
author = {Alfredo Dente and Alberto Bolletta and Stefano Bacchini and Gaia Benvenuti and Anna Scarabosio and David Pakeliani and Eugenio Simoni and Eva Covello and Emanuele Cigna},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207768},
url = {https://www.mdpi.com/2077-0383/15/20/7768},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preoperative High-Resolution Ultrasound-Guided Design of the Fibula Osteoseptocutaneous Flap: A Structured Surgeon-Performed Protocol
AU - Alfredo Dente
AU - Alberto Bolletta
AU - Stefano Bacchini
AU - Gaia Benvenuti
AU - Anna Scarabosio
AU - David Pakeliani
AU - Eugenio Simoni
AU - Eva Covello
AU - Emanuele Cigna
PY - 2026
DA - 2026/10/09
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207768
UR - https://www.mdpi.com/2077-0383/15/20/7768
AB - Background/Objectives: The fibula osteoseptocutaneous flap is an established option for head and neck reconstruction. Preoperative planning requires assessment of donor-limb arterial anatomy and localization of cutaneous perforators. This study describes a structured surgeon-performed Conventional High-Frequency Ultrasound (CHFUS) protocol and evaluates its correlation with intraoperative findings. Methods: This retrospective study included patients undergoing reconstruction with a fibula osteoseptocutaneous free flap between January 2024 and December 2025. A standardized two-phase CHFUS workflow was used to assess infrapopliteal arterial anatomy and identify, characterize, and mark perforators at their deep fascial emergence. Preoperative findings were compared with intraoperative anatomy. Results: Ten patients underwent fibula flap reconstruction. Eighteen perforators were mapped, with a mean of 1.80 ± 0.63 per patient. The most common Kim–Lippert vascular pattern was type I (90%). Mean peroneal artery diameter at its origin was 2.83 ± 0.15 mm, and mean dominant perforator diameter at deep fascial emergence was 1.04 ± 0.14 mm. All 10 patients met the predefined anatomical agreement threshold of ≤1 cm (100%; exact two-sided 95% confidence interval, 69.2–100%). No flap required intraoperative redesign because of perforator anatomy. All flaps survived, without partial skin-paddle necrosis, donor-site ischemia, or vascular complications. Conclusions: This structured surgeon-performed CHFUS protocol was feasible and useful for fibula osteoseptocutaneous flap planning, enabling assessment of arterial anatomy, reliable perforator localization, and translation of preoperative findings into skin-paddle design. CHFUS should be considered complementary to CT angiography. Larger prospective studies are required to evaluate interoperator reproducibility and the diagnostic performance of CHFUS for clinically relevant arterial variants.
SN - 2077-0383
ER -