Surgical and Radiologic Anatomy

, Volume 41, Issue 4, pp 447–454 | Cite as

Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction

  • Lara Nokovitch
  • Julien Davrou
  • François Bidault
  • Bernard Devauchelle
  • Stéphanie Dakpé
  • Christian VacherEmail author
Original Article



Initially described by Baudet in 1982, the fibula flap including the lateral head of the soleus muscle allows a one-stage reconstruction for large maxillo-mandibular defects. The aim of this study was to evaluate the number of muscular branches destined to the soleus muscle and their distance from the origin of the fibular artery, to assess the vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction.


We performed a cadaveric anatomic study on ten lower limbs, and a CT angiography anatomic study on 38 legs. The number of soleus branches originating from the fibular artery, and the distance between the origin of the fibular artery and each of the identified branches were measured.


The number of soleus branches destined to the lateral head of the soleus muscle is variable, with in our study 1–3 branches found. Soleus branches destined to the lateral head of the soleus muscle emerged at a distance ranging between 0 and 2.9 cm (mean value = 1.82 cm) from the origin of the fibular artery in 40% of cases, between 3 and 5.9 cm (mean value = 4.27 cm) from the origin of the fibular artery in 37% of cases, and was at a distance of 6 cm or more (mean value = 6.93 cm) from the origin of the fibular artery in 20% of cases.


An origin of the soleus vessels in close proximity to the origin of the fibular artery represents the main limitation of this flap, the length of the remaining fibular pedicle making it difficult to achieve secure anastomosis in the cervical area. The vascular distribution of the proximal part of the lateral head of the soleus muscle being segmental, it is possible to lengthen the flap pedicle ligating the most proximal soleus branches originating from the fibular artery.


Fibula flap Soleus muscle Reconstruction Pedicle length CT angiography Cadaveric study 


Author contributions

LN: protocol development, data collection, data analysis, manuscript writing. JD: data analysis, manuscript writing. FB: data collection. BD: other. SD: other. CV: protocol development, data analysis, manuscript writing and editing.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest to declare.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Anatomy Laboratory of the University of Medicine Paris V René Descartes, AP-HP Surgical SchoolParisFrance
  2. 2.Department of Maxillo-Facial SurgeryUniversity Hospital of Amiens, Picardie Jules Verne UniversityAmiensFrance
  3. 3.Department of Maxillo-Facial SurgeryBeaujon Hospital, AP-HPClichyFrance
  4. 4.Radiology DepartmentGustave Roussy InstituteVillejuifFrance
  5. 5.University of Medicine Paris-DiderotParisFrance

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