The Peroneal Vessels as Recipient in Free Flaps for Defects near the Ankle: An Alternative to the Anterior Tibial Vessels

Background: Extensive anterolateral defects involving the lower leg, ankle, and proximal foot usually need the use of free flaps for optimal coverage. Usually, anterior tibial vessels are used as recipient vessels for such defects, but in situations where these vessels are not usable either because of a large zone of trauma or pre-existing scarring that may preclude the use of anterior tibial vessels without the use of a vein graft, peroneal vessels can be considered as the recipient vessel. Materials and methods: This retrospective series of six cases define the indications and the outcomes of peroneal vessels as a recipient. Results: In two of six cases, a preliminary exploration of the anterior tibial vessels revealed a non-usable situation. In the other four cases with similar clinical conditions, deliberate exploration of peroneal vessels after excising a segment of the fibula ensured the availability of a healthy recipient for a successful outcome. Discussion: In four cases, there was no morbidity on account of the fibular excision. Two developed ankle instability, but the nature of the injury was partially an attributable cause. Conclusion: The peroneal vessels need to be considered in preference to the posterior tibial as a recipient in extensive anterolateral lower third leg and foot defects crossing the ankle when the anterior tibial is in the zone of trauma or surrounded by scarring.