CC-BY-NC-ND 4.0 · J Reconstr Microsurg Open 2017; 02(02): e90-e93
DOI: 10.1055/s-0037-1604340
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction

Kenji Kawamura1, Shohei Omokawa1, Takamasa Shimizu1, Tadanobu Onishi1, Satoshi Hayashi1, Naoki Maegawa1, Yasuhito Tanaka1
  • 1Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
Further Information

Publication History

01 June 2017

11 June 2017

Publication Date:
24 July 2017 (online)


Background The osteocutaneous fibula flap is an established method for reconstruction of bone and soft tissue defects in the lower extremity. The vascularity of the fibula and overlying skin paddle is usually provided by a single pedicle composed of the peroneal artery. In rare situations, the fibula is supplied by the peroneal artery, whereas the overlying skin paddle is supplied by perforators originating from the posterior tibial artery.

Case Report A 28-year-old man presented with osteomyelitis of the tibia that was scheduled to be treated with a free vascularized osteocutaneous fibula flap from the contralateral lower leg. Intraoperatively, it was found that perforators supplying the skin paddle originated not from the peroneal artery but from the posterior tibial artery. A fibula flap nourished by the peroneal vessels was harvested and the skin paddle was returned to the lower leg. The fibula was fixed at the recipient site, and peroneal vessels were anastomosed to the recipient posterior tibial vessels. The skin defect was successfully managed with a perforator-based propeller flap nourished by the recipient artery.

Conclusion To the best of our knowledge, only five authors have reported this variant vascularity of the osteocutaneous fibula flap. They harvested two independent flaps, one a skin flap and the other a fibula flap, and performed two separate vascular anastomoses at the recipient site. In comparison to previously reported cases, the salvage procedure using a perforator-based propeller flap is easy and reliable because there is no need for additional anastomosis of the perforator vessels.