Chimeric Free Fibula Flap: An Encounter With Aberrant Anatomy.

Dieter Brummund,Angela Chang

doi:10.7759/cureus.10073

Abstract

A 59-year-old male presented with recurrent mucoepidermoid carcinoma of the mandible. A resection with immediate free fibula flap reconstruction was done. The osteocutaneous free fibula flap relies on the peroneal artery and its distal perforators. Variant patterns necessitate consideration of the challenging to dissect proximal myocutaneous perforator raised on a single or double anastomosis, depending on origin. Even in cases of flap salvage, the fibula flap remains a reliable flap. This case describes a fibula flap with a sole proximal myocutaneous perforator identified during dissection despite a normal preoperative Doppler.

Highlights

The flap of choice for mandibular reconstruction is the osteocutaneous free fibula flap, which is based on the peroneal artery and its perforating vessels
We reviewed the literature for similar cases to our fibula flap with no septocutaneous perforator that relied on a single myocutaneous proximal peroneal artery perforator
The flap was salvaged by carefully extending the dissection proximally until a myocutaneous perforator was found

Summary

Introduction

The flap of choice for mandibular reconstruction is the osteocutaneous free fibula flap, which is based on the peroneal artery and its perforating vessels. Variant terminal branching of the popliteal artery occurs at a rate of approximately 10% in anatomic studies, with the three most common branding patterns being popliteal trifurcation, anterior tibioperoneal trunk, and high terminal division [3]. While these variants exist, preoperative angiography is generally only warranted in patients with a history of lower extremity trauma and or abnormal clinical examination of pulses and Doppler signals of the extremity [4]. A single myocutaneous perforator was identified originating from the peroneal artery just distal to the tibioperoneal bifurcation (Figure 2). The patient suffered no significant postoperative complications and was discharged home on postoperative day 5

Discussion

Conclusions

Findings

Disclosures

Daya M