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Many authors have defined the anatomy of the blood supply to the lateral leg skin, especially with regard to the osteocutaneous fibular flap, yet complete anatomical description and an useful information of how to elevate a skin paddle with bone reliably are lacking. To improve the surgical skill and to have precise informations for safer elevation of osteocutaneous fibular flap, 1) general neuro-vascular anatomy, including the musculo-periosteal blood supply of the fibula, 2) the number, origin, course, distribution, length, and size of cutaneous branches, 3) the number and location of nutrient artery were investigated using fixed 17 Caucasian legs.(4 males and 5 females, mean age of 75.7 years) Findings were as follows: 1. The fibula had the uniform pattern of periosteal blood supply. The musculo-tendo-periosteal branches, which supply the segmental blood supply to the fibula, distributed mostly at the level of 20 to 75% of fibula shaft. 2. Total number of the cutaneous branches at their origin was 117. Of these, 83 branches (70.9%) were peroneal arterial origin. The average number of cutaneous branches (at the level of origin) per leg from the peroneal artery was 4.82+/-1.63. They were distributed through 20 to 100% of the fibula length with the maximum distribution in 30~40%. 3. At the level of skin, total number of the cutaneous branches was 165. Of these, 122 branches(73.9%) were peroneal arterial origin. The average number of peripheral cutaneous branches per leg from the peroneal artery was 7.18+/-2.46. They were distributed through 20 to 100% of the fibula length with the maximum distribution in 50~ 60%. 4. The cutaneous branches could be classified as septocutaneous and musculocutaneous type at the level of their origin. The average number of septocutaneous vessels per leg was 3.82+/-1.38; while musculocutaneous, 1.06+/-1.03. The septocutaneous vessels were distributed through the fibular length(10~100%), with the maximum incidence in 80~90%. While, musculocutaneous branches were branched from the peroneal artery mainly at the level of 10 to 80%, with the maximum incidence in 20~30%. 5. The cutaneous branches at the level of skin could be classified as septocutaneous, septomusculocutaneous and musculocutaneous type. The average number of septocutaneous vessels per leg was 4.53+/-1.41; septomusculocutaneous type, 0.68+/-0.93; musculocutaneous, 2.0+/-1.84. The septocutaneous branches were distributed over 20~100% of the fibula length, with the maximum incidence in 80~90%. Musculocutaneous branches were at the level of 10~90% with peak at 30~40% of the fibula length, and the septomusculocutaneous branches, 20~80%. 6. Medium to large-caliber cutaneous vessels were branched frequently from the peroneal artery at 20~60% (peak incidence, 30~40%) of the fibula length. While they were found at the lateral skin at the level of 30-80% (peak incidence, 70~80%). 7. The length of cutaneous branches were 56.0+/-36.4mm in average (that of septocutaneous type, 42.6+/-20.0mm; septomusculocutaneous, 95.6+/-50.2mm; musculocutaneous, 75.2+/-43.6mm).
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