Vascularized fibular grafts ( VFG ) are usually harvested based on the peroneal artery and is useful for reconstructing long bone defects. Most of the branching patterns of the popliteal artery are normal, and providing the surgeon performs the dissection meticulously VFG flaps can be harvested safely together with the peroneal artery. However, our knowledge regarding variations in vascular anatomy is based on angiographic and cadaveric studies. In patients scheduled to undergo VFG transfer procedures, it is important to be aware of vascular abnormalities preoperatively to be able to preserve the arterial supply to the foot as well as the fibular circulation. In this report, we describe the case of a patient who sustained a 15-cm bone defect due to the removal of osteomyelitic bone after the open reduction and internal fixation of a tibial fracture. During preoperative computed tomography angiography ( to plan for a VFG transfer procedure ), a rare vascular variant was identified ; i.e., the foot was solely nourished by dominant peroneal artery because the anterior and posterior tibial arteries were hypoplastic.
