Peroneal artery perforator chimeric flap: changing the perspective in free fibula flap use in complex oromandibular reconstruction.

The fibula osteoseptocutaneous flap has undergone multiple refinements since its first description in oromandibular reconstruction. There is now a better understanding of the blood supply to the skin of the lateral aspect of the leg. Multiple free skin paddles can be harvested freestyle from the lateral aspect of the leg. The size of the flaps that can be harvested has not been clearly defined. A case report of a complex oromandibular reconstruction following a shotgun injury to the face demonstrates a way of maximizing the skin harvest. An osteoseptocutaneous fibula flap was used for the replacement of the mandible and the internal lining of the oral cavity. A larger lateral leg flap based on a musculocutaneous perforator of the peroneal artery was used for the external and full-thickness lower-lip defect. The latter flap by definition is a peroneal artery perforator flap, which to the best of my knowledge is terminology that has not been used in the English literature. The main purpose of this article is to review the blood supply of the lateral leg and how this can be utilized to reach the goals of a complex oromandibular and total lower-lip reconstruction.