The free fibula flap is widely used for mandibular reconstruction, allowing simultaneous reconstruction of bone and soft tissue. However, anatomical variations of the perforator supplying the skin paddle may complicate its preservation.
Here, we report a case in which the perforator originated from the tibioperoneal trunk instead of the peroneal vessels. The perforator was dissected proximally and transected after branching from the tibioperoneal trunk and was then anastomosed to the distal end of the peroneal vessels, enabling preservation of the skin paddle as a chimeric flap.
The flap survived completely, and no postoperative complications, including infection, were observed. This technique may be a useful option for preserving the skin paddle in cases with anatomical variations of the perforator.
