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Choudhary et al. Plast Aesthet Res 2022;9:3 Plastic and
DOI: 10.20517/2347-9264.2021.68
Aesthetic Research

Case Report Open Access

Avoiding second donor site and the second set of
neck vessels in a case of absent peroneal skin

perforators

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Aditya Narayan Choudhary , Rajan Arora , Kripa Shanker Mishra , Ravi Kiran Naalla , Saket Srivastava ,
Ajay Kumar Dewan 2
1
Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
110085, India.
2
Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi 110085, India.
Correspondence to: Dr. Kripa Shanker Mishra, Department of Reconstructive and Microvascular Surgery, Rajiv Gandhi Cancer
Institute and Research Centre, Rohini, Sector-5, New Delhi 110085, India. E-mail: drksmishra25@gmail.com
How to cite this article: Choudhary AN, Arora R, Mishra KS, Naalla RK, Srivastava S, Dewan AK. Avoiding second donor site and
the second set of neck vessels in a case of absent peroneal skin perforators. Plast Aesthet Res 2022;9:3.
https://dx.doi.org/10.20517/2347-9264.2021.68

Received: 17 Jun 2021 First Decision: 12 Oct 2021 Revised: 12 Nov 2021 Accepted: 24 Nov 2021 Punlished: 14 Jan 2022

Academic Editors: Matthew Spector, Mark K. Wax Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply
solely from a soleal musculocutaneous perforator originating from the posterior tibial system. In contrast, the
osteo-muscular component was supplied by the peroneal vascular system. We harvested the skin paddle with its
vascular supply from the posterior tibial artery separately, and the osteo-muscular fibula was harvested with its
supply from peroneal vessels. In this way, we avoided violation of the second donor site for the skin paddle. In
addition, we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of
neck vessels for anastomosis. This technique may also be utilised in cases where the neck vessels may not be
available due to previous surgeries, radiation therapy, or decision by the surgery team to not sacrifice two sets of
neck vessels for anastomosis.

Keywords: Free fibula flap, peroneal vessels, posterior tibial vessels, mandible reconstruction, flaps in series

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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