The fibular osteocutaneous free flap has become a well-accepted method of mandibular reconstruction. Aberrations in the blood supply to the foot affect 5% to 7% of the population, and substantial atherosclerotic disease of the lower extremities is often found in elderly individuals, many of whom have been smokers. Therefore, the use of preoperative vascular imaging is justified in all patients scheduled for fibular osteocutaneous free-flap harvest. In a series of 25 consecutive patients clinically judged to be satisfactory candidates for fibular free-flap reconstruction, preoperative arteriograms excluded 4 patients from use of this donor site and determined which leg was used in 2 other patients.