Reverse venous outflow of a free fibular osteocutaneous flap: A salvage procedure

The authors report 2 patients with a massive bony defect of the tibia due t o chronic osteomyelitis. They reconstructed the defect using a free vascula rized fibular osteocutaneous flap, Unfortunately, venous insufficiency was diagnosed 24 hours postoperatively. The previous anastomosed veins were pro mptly explored. The peroneal veins of the vascularized fibular bone graft w ere noted to be full of thrombi. After thrombectomy, the vessels became ver y fragile and broke down easily. It was impossible to achieve normal antegr ade venous outflow from the previous vein of the donor graft; however, they found that distal runoff of the peroneal vein achieved a reverse venous ou tflow from the donor graft. The great saphenous vein was dissected and rean astomosed to achieve adequate venous drainage. This procedure may offer an alternative treatment for a flap with venous insufficiency.