The fibula is the lateral, non-weight-bearing bone of the leg. The proximal and distal segments contribute to translational stability of the knee and ankle joints. The fibula flap is vascularized by the peroneal vessels, which bifurcate from the tibi-operoneal trunk (Fig. 213.1). This occurs 3 to 4 cm below the bifurcation of the popliteal and anterior tibial arteries. The pedicle remains within the deep posterior compartment of the leg until the distal third. The pedicle resides between the flexor hallucis longus posteriorly and the tibialis posterior anteriorly, with the fibula lateral to the vessels. As the vessels descend to
the fibula, they provide four to six segmental perforators to the bone, periosteum, and surrounding musculature allowing flexibility in tissue harvest and bony osteotomies. A nutrient branch of the peroneal artery, which enters the posteromedial fibula in the mid-diaphysis, provides endosteal circulation. The surgeon should be aware of the bifurcation of the common peroneal nerve at the fibular head proximally. Vascular abnormalities including arteriosclerotic disease and peroneal arteria magna are contraindications to this flap. Up to 15% of the population possess a peroneal arteria magna anomaly in which the blood supply to the foot is derived solely from the peroneal artery (6).