The fibular nutrient artery is a branch of the peroneal artery entering the fibula through its nutrient foramen in the proximal third, providing the primary endosteal blood supply to the fibular cortex. It is the dominant intraosseous vessel and must be preserved when using fibular grafts with limited periosteal stripping.
Preservation of the fibular nutrient artery is critical in fibular free flap harvest for jaw reconstruction, as its inclusion within the graft ensures reliable cortical bone vascularity. The nutrient foramen is located in the posterior fibular cortex approximately 10-15 cm from the fibular head. In fibular fractures, disruption of the nutrient artery contributes to delayed union in the fibular shaft. The peroneal artery, from which the nutrient vessel branches, is the primary pedicle of the fibular free flap.
Injury to the fibular intraosseous blood supply from fibular shaft fracture or periosteal stripping, contributing to fibular delayed union or non-union and devascularisation of the fibular free flap if the nutrient pedicle is damaged during harvest.
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