Is it safe to harvest a proximally fractured fibula as an osseocutaneous anterograde pedicled flap for proximal tibial reconstruction in subacute period? A case report and literature review.

Osteoseptocutaneous fibula flap is commonly used as the workhorse flap for bone reconstruction. However, the use of previously fractured fibula as a free or pedicled flap for bone reconstruction has a limited knowledge in the literature. There is not any data in the literature about a case with proximal level of fibula fracture which was used as an anterograde pedicled osteocutaneous fibula flap for composite tibial reconstruction after high-energy injury. Based on a patient in whom the composite defect of the proximal tibial region was reconstructed with osteocutaneous fibula flap after a gunshot injury, it was tried to show that the fibula with a proximal level fracture could be used with anterograde flow in the subacute period and it is thought that the usability of this flap should be kept in mind. It is possible to harvest the pedicled fibula flap even in the subacute period with the evaluation of CT angiography preoperatively and with the checking the patency and flow direction of peroneal artery perioperatively. The success of the procedure may be increased through total dissection of inflammatory areas of pedicle which would extend into the injury zone during the subacute period.