ABSTRACT
Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous
perforators, musculocutaneous perforators or from both, and these perforators might
originate from the peroneal or posterior tibial vessels or from both. The objective
of this study was to classify the skin paddles based on the dominance of vascular
contribution by these axial vessels through their different perforator systems. Materials and Methods: A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular
reconstruction was done and the skin paddle vascularity was studied. While majority
of the skin paddles received their blood supply from the peroneal septocutaneous perforators,
a few had their dominant supply from the soleus musculocutaneous perforators in addition
to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous
perforators were the sole source of blood supply to the skin paddle. The limitation
in this study was the inability to augment the clinical observation with cadaveric
study. Results: The skin paddle of the free fibula flap was classified into four different types
(a-d) based on the dominance of vascular contribution by axial vessels of the leg.
Conclusion: The skin paddle of the free fibula flap has reliable blood supply, but a thorough
knowledge of the variations in vascular pattern of the skin paddle is required especially
to salvage the larger paddles used in the reconstruction complex oro-mandibular defects.
KEY WORDS
Free fibula flap - musculocutaneous perforators - septo cutaneous perforators - skin
paddle - vascular supply
