ABSTRACT
The free osteocutaneous fibula flap is an established method of reconstruction of
maxillary and mandibular defects. The vascularity of the skeletal and the cutaneous
components is provided by the peroneal artery via the nutrient artery and the septo-
and musculocutaneous perforators. In rare situations, these perforators may arise
from other major leg arteries. In such circumstances, the procedure has to be either
abandoned or modified so that neither the vascularity of the flap nor the donor limb
is compromised. We present a case of an anomalous musculocutaneous perforator, which
originated from the proximal part of the posterior tibial artery, passed through the
soleus muscle and supplied the skin paddle. The flap was elevated as a single composite
unit and was managed by two separate vascular anastomosis at the recipient site, one
for the peroneal vessels and the other for the anomalous perforator.
KEY WORDS
Anomalous perforator - double vascular anastomosis - osteocutaneous fibula flap
