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Peroneal pedicle: An underutilized recipient vessel

Introduction: Anterior and Posterior tibial vessels are commonly used for anastomosis in lower limb reconstruction. There are situations when both of these vessels have inadequate flow or the lie of the adjacent vessel in relation to the flap is not conducive for total coverage of the defect. In these situations, Peroneal pedicle can be used as the recipient vessel for free tissue transfer. We present our experience of using Peroneal pedicle as recipient vessel for successful free tissue transfer. Methods: All the patients undergoing free tissue transfer for lower limb reconstruction having anastomosis with Peroneal vessels were included. The patients fall under two groups. 1. Trauma- 6 patients with complex defect due to trauma had normal palpable distal pulsations at ankle but the target vessel was thrombosed, flap orientation was not conducive for the other vessel hence intraoperative decision to use Peroneal vessels was made. 2. Diabetic foot- Three patients had clinically non palpable pulsations at the ankle. They had biphasic flow in both the Tibial vessels and triphasic in peroneal as confirmed preoperatively with color Doppler. Free flaps were done using the anastomosis to Peroneal vessels. Results: Of 182 free flaps for lower limb reconstruction in last 4 years we have used Peroneal vessels as recipient pedicle in nine patients for successful free tissue transfer. All the flaps survived without any complication. Conclusion: Peroneal pedicle can be safely utilized as recipient vessel for free to free transfer in special situations. This is an underutilized pedicle to reconstruct many complex defects.