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Best of Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Two-vessel Lower Extremity Runoff and Donor-site Vascular Complications Following Fibular Free Flap Harvest

Sunday, October 18, 2026

2:54 PM - 3:00 PM PT

Location: West Exhibit Hall A, Learning Zone 6

Presenting Author(s)

Corinne Negvesky, BS

Medical Student
UCLA
Los Angeles, CA, United States

Co-Author(s)

SH

Song Hon Hwang, MD

PGY-5
UCLA Department of Head & Neck Surgery
Los Angeles, CA, United States
Garrett Ni, MD

Clinical Instructor
UCLA Department of Head & Neck Surgery
Tigard, Oregon, United States
EO

Eugene Oh, MD

PGY-1
UCLA Department of Head and Neck Surgery
Los Angeles, CA, United States
Shady I. Soliman, MD, MS

PGY-3
UCLA Department of Head & Neck Surgery
Santa Monica, California, United States
KB

Keith Blackwell, MD

Professor
UCLA Department of Head & Neck Surgery
Los Angeles, California, United States

Senior Author(s)

RK

Robert S. Kang, MD, MPH

Assistant Professor
UCLA Department of Head & Neck Surgery
Los Angeles, California, United States

Introduction: Preoperative assessment of lower leg runoff is critical in fibular free flap donor selection, yet its relationship with donor-site vascular complications remains poorly defined. This study evaluated the association between lower leg runoff patterns and donor-site vascular complications following fibular free flap harvest.

Methods: We conducted a retrospective observational study using institutional medical record review of patients undergoing fibular free flap surgery at Ronald Reagan UCLA Medical Center between April 1996 and December 2019, of whom 787 met inclusion criteria. Associations between lower leg runoff anatomy, radiation exposure category, and postoperative donor-site vascular complications were evaluated using Fisher’s exact test.

Results: Among 787 patients meeting inclusion criteria, 1.1% had 1-vessel, 12.2% had two-vessel, and 86.7% had three-vessel runoff to the foot in the donor leg. Complication rates did not differ significantly by runoff anatomy (p=0.635). The overall vascular complication rate was 0.9%, with only one of seven patients experiencing a complication having occlusive atherosclerotic disease. Vascular complication rates differed significantly by radiation exposure category, with the highest rates observed among patients who received both pre- and postoperative radiation (p=0.018). Vascular complications were not significantly associated with prior surgery, prior chemotherapy, osteoporosis, coronary artery disease, diabetes, smoking history, imaging modality, sex, or laterality of donor leg.

Conclusions: A two-vessel runoff vessel anatomy of the lower leg was not associated with an increased risk for donor leg vascular complications when compared to the normal three-vessel anatomy, whereas radiation exposure timing was associated with higher complication rates.