Anatomical analysis of the periosteal blood supply system of the fibula using fresh cadavers

A vascularized free fibula flap is often used to reconstruct bone defects. However, bone resorption within the osteotomized segment is often observed. This may be attributed to damage to bone blood flow supplied by nonpenetrating periosteal vessels (NPPVs); however, there are few studies on NPPVs in the fibula. In this study, we investigated dissection methods to assess the vascular network in the fibula and performed a detailed anatomical investigation of NPPVs using fresh cadavers provided by the Clinical Anatomy Laboratory at the Keio University. Three dissection methods were compared to assess the vascular network, and data on the branching, distribution, and number of NPPVs from the peroneal artery were collected. A method involving the elevation of the periosteal bone flap was found to be the most acceptable for assessing fibular NPPVs with less vascular damage. A total of 13 limbs from 7 male and 2 female cadavers were dissected. The number of detected NPPVs was 12-23 per limb (median: 17). No nutrient vessels were detected 5 cm from the proximal and distal ends of the fibula. Fibular NPPVs were distributed in the anterior and posterior directions along the peroneal artery trunk, with more NPPVs toward the posterior. Among the osteotomized segments of 1.0 cm, 30% did not contain any NPPVs, whereas segmentations of 1.5, 2.0, and 3.0 cm resulted in 87%, 95%, and 99% of the segments with at least one NPPV, respectively. These findings for the vascular network in the fibula may help to improve the graft blood supply and prognosis.