{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:18:11Z","timestamp":1787699891217,"version":"build-2784847793"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Reliable identification of septocutaneous fibular artery perforators is important for free fibula flap harvest involving a skin paddle. While imaging modalities such as computed tomography angiography (CTA) provide high diagnostic accuracy for direct perforator visualization, they do not quantify segment-level probability of perforator presence based on global anatomical characteristics.<\/jats:p>\n                  <jats:p>In this retrospective CTA-based study, 246 patients (490 limbs) were analyzed. Each fibula was divided into 10 equal segments, yielding 4,900 limb-zone observations. Using limb-level anatomical and vascular parameters, machine learning models were developed to predict the presence of at least one perforator per segment. Data were split at the patient level (80% training, 20% testing). Model performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), area under the precision\u2013recall curve (PR-AUC), and Brier score.<\/jats:p>\n                  <jats:p>Overall segment-level perforator prevalence was 15.4%, and 20.6% of limbs exhibited no septocutaneous perforator. Ridge-regularized logistic regression (primary model) achieved a ROC-AUC of 0.684, PR-AUC of 0.243, and Brier score of 0.1214. Random forest achieved a ROC-AUC of 0.705, PR-AUC of 0.239, and Brier score of 0.1216. XGBoost achieved a ROC-AUC of 0.710, PR-AUC of 0.245, and Brier score of 0.1213. The generalized additive model yielded a ROC-AUC of 0.683, PR-AUC of 0.231, and Brier score of 0.1223. All approaches reproduced the characteristic midfibular peak in perforator probability.<\/jats:p>\n                  <jats:p>Machine learning enables moderate segment-level discrimination of perforator presence based on global anatomical features. While not comparable to imaging for direct vessel localization, probabilistic modeling may complement imaging by providing structured, patient-specific estimation of regional perforator likelihood.<\/jats:p>","DOI":"10.1055\/a-2936-1847","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:53:53Z","timestamp":1787698433000},"source":"Crossref","is-referenced-by-count":0,"title":["Machine Learning\u2013Based Prediction of Fibular Artery Septocutaneous Perforators"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5520-4635","authenticated-orcid":false,"given":"Jannik","family":"Ketschau","sequence":"first","affiliation":[{"name":"TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2518-4583","authenticated-orcid":false,"given":"Jonathan","family":"Mohr","sequence":"first","affiliation":[{"name":"TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannik","family":"Leonhardt","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Institute of Diagnostic and Interventional Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Krautkremer","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Brandt","sequence":"additional","affiliation":[{"name":"Technical University of Munich and TUM University Hospital, Bavaria, Germany","place":["Munich"],"department":["Chair for AI in Healthcare and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Fichter","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Department of Oral and Maxillofacial Surgery"]},{"name":"University Hospital Leipzig, Saxony, Germany","place":["Leipzig"],"department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-0344","authenticated-orcid":false,"given":"Lucas M.","family":"Ritschl","sequence":"additional","affiliation":[{"name":"TUM University Hospital Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Bavaria, Germany","place":["Munich"],"department":["Department of Oral and Maxillofacial Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/PRS.0b013e31821e7058","article-title":"Design of a reliable skin paddle for the fibula osteocutaneous flap: perforator anatomy revisited","volume":"128","author":"P Yu","year":"2011","journal-title":"Plast Reconstr 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