Peronea Arteria Magna: a rare but surgically important variant for prevention of post-surgical limb loss.

PURPOSE: A large number of anatomic variants occur in the lower limb arteries and the Peronea Arteria Magna (PAM) is a rare congenital variant where the fibular/peroneal artery becomes the dominant arterial supply to the leg foot, replacing hypoplastic anterior and posterior tibial arteries. It is imperative that the operative surgeon be aware of this anomaly prior to obtaining the fibula osteocutaneous free tissue flap (OFF) so that post-surgical limb loss can be prevented. METHODS: We present a case of a young male who was posted for reconstructive surgery with OFF, after undergoing right hemi-mandibulectomy for Juvenile ossifying fibroma. On examination, he had bilateral distal feeble pulses and was advised CT Angiography (CTA). RESULTS: Preoperative CTA showed patent bilateral popliteal arteries with a Type III C branching pattern, characteristic of PAM. The patient was hence advised against OFF. CONCLUSION: This case report highlights the incidental detection of PAM during preoperative evaluation for OFF. The identification of PAM through CTA proved critical in preventing potential limb-threatening complications, underscoring the essential role of CTA for vascular imaging in pre-surgical planning for OFF.