{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:03:42Z","timestamp":1789513422546,"version":"build-2803163510"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Head and neck squamous cell carcinoma accounts for 4.5% of all new cancers diagnosed. A fibula free flap is often performed after tumor resection. Preoperative acknowledgment of the branching patterns of the popliteal artery is important to avoid flap failure or leg ischemia after flap harvest. We performed this extensive study using a modified classification to help thoroughly recognize variations.<\/jats:p>\n                  <jats:p>The subjects were Taiwanese patients who received radiologic examinations of their lower limbs at a single medical center from May 2006 to December 2022. Only digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography, which reveal the vasculature of the lower limbs, were included. All images were viewed by the same plastic surgeon on the same computer screen. Statistical analysis was subsequently performed on the data.<\/jats:p>\n                  <jats:p>In total, 1,244 right legs and 1,198 left legs (2,442 legs in total) from 1,485 Taiwanese patients were included in this study. In addition to normal branching, type IA, other branching patterns as variations occurred in 4.1% (n\u2009=\u2009100) of the included legs. The second and third common patterns were type IIIA (1.06%, n\u2009=\u200926) and IB (0.98%, n\u2009=\u200924), respectively. Forty-seven patients presented with variation and had both legs evaluated, and 29.8% of them presented with bilateral variations.<\/jats:p>\n                  <jats:p>A preoperative vascular examination is strongly recommended before harvesting a free fibular flap because some patients might have a blood supply to the foot and lower leg, mainly from the planned-to-be-harvested peroneal artery (PR), or might not have a workable PR. Using fibular vessels as a flap pedicle might not be able to be performed in up to 1.84% of legs.<\/jats:p>","DOI":"10.1055\/a-2717-4092","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T22:51:04Z","timestamp":1760050264000},"page":"667-673","source":"Crossref","is-referenced-by-count":2,"title":["Largest Investigation of Branching Patterns of the Popliteal Artery"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9308-7808","authenticated-orcid":false,"given":"Cen-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui-Po","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Ting","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Hsiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3390\/medsci11020042","article-title":"Epidemiology, risk factors, and prevention of head and neck squamous cell carcinoma","volume":"11","author":"A Barsouk","year":"2023","journal-title":"Med Sci (Basel)"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3390\/ijerph17020665","article-title":"Assessment of the risk of oral cancer incidence in a high-risk population and establishment of a predictive model for oral cancer incidence using a population-based cohort in Taiwan","volume":"17","author":"L C Hung","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/PRS.0b013e3181c2bb9d","article-title":"Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction","volume":"125","author":"C G Wallace","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.jcms.2018.03.022","article-title":"Patient-specific pre-contouring of osteosynthesis plates for mandibular reconstruction: using a three-dimensional key printed solution","volume":"46","author":"J Kraeima","year":"2018","journal-title":"J Craniomaxillofac Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s10856-018-6029-5","article-title":"3D printed models in mandibular reconstruction with bony free flaps","volume":"29","author":"B Jacek","year":"2018","journal-title":"J Mater Sci Mater Med"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1002\/micr.30016","article-title":"Anatomical variants of lower limb vasculature and implications for free fibula flap: systematic review and critical analysis","volume":"36","author":"A K Abou-Foul","year":"2016","journal-title":"Microsurgery"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jvs.2016.01.043","article-title":"The evidence-based surgical anatomy of the popliteal artery and the variations in its branching patterns","volume":"65","author":"K A Tomaszewski","year":"2017","journal-title":"J Vasc Surg"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.diii.2016.02.014","article-title":"Anatomic variations of popliteal artery: evaluation with 128-section CT-angiography in 1261 lower limbs","volume":"97","author":"H Demirta\u015f","year":"2016","journal-title":"Diagn Interv Imaging"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/00000658-198912000-00014","article-title":"Surgical significance of popliteal arterial variants. A unified angiographic classification","volume":"210","author":"D Kim","year":"1989","journal-title":"Ann Surg"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1007\/s00276-019-02262-3","article-title":"Variations in terminal branches of the popliteal artery: cadaveric study","volume":"41","author":"\u0141 Olewnik","year":"2019","journal-title":"Surg Radiol Anat"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.crad.2006.03.014","article-title":"Popliteal artery branching patterns \u2013 an angiographic study","volume":"61","author":"C P Day","year":"2006","journal-title":"Clin Radiol"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00270-008-9460-z","article-title":"Anatomical variations of the popliteal artery and its tibial branches: analysis in 1242 extremities","volume":"32","author":"S W Kil","year":"2009","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"19584","DOI":"10.1038\/s41598-021-99203-1","article-title":"The congenital popliteal vasculature patterns in fibular free flap reconstruction by means of surgical anatomy in cadavers","volume":"11","author":"M Ongsiriporn","year":"2021","journal-title":"Sci Rep"},{"issue":"06","key":"ref15","first-page":"e63092","article-title":"Variations in the termination of the popliteal artery: a multidetector computed tomography angiography (CTA)-based retrospective study","volume":"16","author":"A Rai","year":"2024","journal-title":"Cureus"},{"issue":"04","key":"ref16","first-page":"423","article-title":"Intra-operative acute leg ischaemia after free fibula flap harvest for mandible reconstruction","volume":"106","author":"P Astarci","year":"2006","journal-title":"Acta Chir Belg"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1055\/s-0038-1677012","article-title":"Preoperative angiography for free fibula flap harvest: a meta-analysis","volume":"35","author":"N Alolabi","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1055\/s-0042-1744411","article-title":"A lucky case of successful free fibula osteocutaneous flap harvest in peronea arteria magna","volume":"49","author":"M A Rosli","year":"2022","journal-title":"Arch Plast Surg"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.2214\/AJR.04.1950","article-title":"Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making","volume":"188","author":"A M Kelly","year":"2007","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"8147","DOI":"10.1038\/s41598-020-65045-6","article-title":"Popliteal artery branching variations: a study on multidetector CT angiography","volume":"10","author":"S Oner","year":"2020","journal-title":"Sci Rep"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s00270-018-1911-6","article-title":"Combined static and dynamic computed tomography angiography of peripheral artery occlusive disease: comparison with magnetic resonance angiography","volume":"41","author":"P Riffel","year":"2018","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.3390\/diagnostics11101865","article-title":"Computed tomography angiography (CTA) before reconstructive jaw surgery using fibula free flap: retrospective analysis of vascular architecture","volume":"11","author":"M Knitschke","year":"2021","journal-title":"Diagnostics (Basel)"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2717-4092.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:35:21Z","timestamp":1789511721000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2717-4092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":21,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2026,9,15]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2717-4092","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10,9]]},"published":{"date-parts":[[2025,10,9]]}}}