Abstract
A case of salvaging an osteocutaneous fibula free flap using the venous flow-through principle has been presented. Because there appeared to be total occlusion of the peroneal artery during flap harvest, the peroneal vein was used as an anterograde venous flow-through pedicle. The surviving bone graft had to be perfused retrogradely through multiple connecting veins. Although it appeared to be a successful solution for the totally occluded peroneal artery, and several possible perfusion pathways have been suggested, we do not recommend that the venous flow-through fibula free flap be used as a standard lifeboat procedure, because its exact perfusion mechanism remains unclear. Copyright
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