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

The vascularized free osteocutaneous fibula flap has become a universal technique for reconstruction of bone and soft tissue defects in the lower leg since Taylor et alfirst described it in 1975.1 The fibula and overlying skin paddle are usually nourished by a single pedicle composed of the peroneal artery and comitant veins. However, to the best of our knowledge, five authors have described a rare variant where the fibula was supplied by the peroneal artery, and the overlying skin paddle was supplied by the perforators originating from the posterior tibial artery.2–6 In such rare situations, the fibula and skin flaps would have to be revascularized separately and the skin paddle cannot serve as a monitor for the fibula. We present a rare variant encountered while elevating an osteocutaneous fibula flap