Survival of the Fibula Osteoseptocutaneous Flap with Thrombosis of Peroneal Veins on Harvesting-Case Report

Abstract

Management of bone loss that occurs after severe trauma of open lower extremity fractures remains a challenge to reconstructive surgeons. For patients with lower limb trauma, an osteocutaneous flap may be required when there are simultaneous defects of bone and soft tissue. We present a case where thrombosis in the peroneal veins of the fibula osteoseptocutaneous flap was encountered during the harvest. The mistake happened as the injury to the donor leg was inconspicuous and angiography was not routinely performed before harvesting. Here we describe a clinical situation in which bone marrow was used for drainage of venous blood in a free fibula osteoseptocutaneous flap. There were two important factors accounting for the survival of this large fibula osteoseptocutaneous flap. (1) In this flap, the arterial circuit was designed so that the two ends of the peroneal artery in the fibula flap were anastomosed to the anterior tibial artery and a branch of the great saphenous vein, to establish the flow-through mechanism. This constituted an uninterrupted arterial circulation. (2) The major venous drainage was through bone marrow. Although there was initial venous congestion and necrosis of the skin paddle, bone and most of the soft tissue survived. Roentgenogram and periosteal abundant vascularity demonstrated bone survival and gradual healing. After rehabilitation, the patient can stand up and walk with the traumatic leg tolerating partial weight bearing after 9 months.