Abstract
This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply solely from a soleal musculocutaneous perforator originating from the posterior tibial system. In contrast, the osteo-muscular component was supplied by the peroneal vascular system. We harvested the skin paddle with its vascular supply from the posterior tibial artery separately, and the osteo-muscular fibula was harvested with its supply from peroneal vessels. In this way, we avoided violation of the second donor site for the skin paddle. In addition, we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of neck vessels for anastomosis. This technique may also be utilised in cases where the neck vessels may not be available due to previous surgeries, radiation therapy, or decision by the surgery team to not sacrifice two sets of neck vessels for anastomosis.
Highlights
The free fibula flap has become one of the most commonly used vascularized bony flaps to reconstruct bony defects in the body[1], the mandible
The skin paddle was designed in eccentric fashion and the short limb was kept towards the distal end of the fibula for easy anastomosis
The skin has served a critical role as a cutaneous component
Summary
The free fibula flap has become one of the most commonly used vascularized bony flaps to reconstruct bony defects in the body[1], the mandible It has a reliable blood supply and a sizable bone stock. The fibula receives its blood supply through the nutrient artery and periosteum, and at the same time, the skin is perfused by septocutaneous/musculocutaneous perforators These skin perforators may arise from posterior or anterior tibial vessels[2]. The skin paddle was designed in eccentric fashion and the short limb was kept towards the distal end of the fibula for easy anastomosis In this whole process, the posterior tibial vessels were left intact and limb vascularity was not compromised anywhere. The venae comitantes of the skin paddle were anastomosed endto-end to the peroneal venae comitantes Both flaps were well perfused at the end of the procedure. In follow-up period, both the donor leg and flap recipient sites healed uneventfully [Figures 4-6]
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