Skin paddle salvage in the fibula osteocutaneous free flap with secondary skin paddle vascular anastomosis.

The fibular osteocutaneous free flap has become a popular choice for the reconstruction of bone and skin defects. A potential drawback has been the reported unreliability of the skin paddle. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present either in the intermuscular septum or in the soleus. Two cases are presented in which the skin paddle was found to be supplied by vessels arising from the proximal peroneal artery. there were no intraseptal or intramuscular vessels in the osteocutaneous septum which connected to the overlying skin paddle. The skin island was salvaged by performing independent microsurgical anastomoses of the fibular graft and the skin paddle. Both patients had complete survival of the fibula and overlying skin paddle.