Lower limb varicose veins in free fibula flap reconstruction: a surgical case report and scoping review

Background Mandibular reconstruction using a vascularized free fibular flap (FFF) remains a gold standard following oral cancer resection. Lower-limb varicose veins are a common manifestation of chronic venous disease, but their potential impact on free-flap viability is largely unexplored in the surgical literature.Case presentation We present a case of FFF reconstruction in a patient with lower extremity varicose veins, detailing the intraoperative management of venous congestion and the postoperative course.Methods We conducted a scoping review to identify publications addressing venous disease or abnormal venous findings in the context of FFF reconstruction.Results The scoping review identified only two relevant publications.Conclusion This report identifies an evidence gap regarding the relevance of donor-site venous findings in FFF reconstruction. The present case and limited literature are hypothesis-generating and do not establish a causal relationship between superficial varicose veins and flap compromise. Further research is needed to clarify whether targeted venous assessment has a role in selected patients.