An anomalous septocutaneous perforator to the skin paddle of the fibula osteocutaneous flap originating from the posterior tibial artery.

The fibula osteocutaneous flap with a distally-sited skin paddle is the preferred design for oromandibular reconstruction because the skin has a reliable blood supply. It is supplied by the peroneal septocutaneous perforator which travels within the posterior crural septum. We report a case of variant anatomy where the septocutaneous perforator originated not from the peroneal artery but from the posterior tibial artery. The clinical implications and techniques for overcoming this anomalous situation are discussed.