Preoperative High-Resolution Ultrasound-Guided Design of the Fibula Osteoseptocutaneous Flap: A Structured Surgeon-Performed Protocol

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.