Medial Plantar Artery Perforator Flap Based on an Aberrant Peroneal Artery Branch for Lower Limb Reconstruction: A Case Report

The medial plantar artery perforator flap (MPAF) is a fasciocutaneous flap that typically arises from the posterior tibial artery (PTA). It is a reliable reconstructive option in both trauma and elective settings. We present two successful cases of distal lower limb reconstruction using an MPAF arising from the peroneal artery. In both patients, CT angiography demonstrated an absent or hypoplastic PTA with a dominant peroneal artery supplying the plantar foot. Recognition of vascular anomalies, such as peroneal artery dominance, and the use of preoperative imaging are crucial for surgical planning. To our knowledge, these are the first reported cases of MPAFs originating from the peroneal artery.