The anatomy of the extended peroneal venous system

The fibula has deservedly become a workhorse flap for vascularized bone gra fts. As with most flaps, much is known regarding idiosyncrasies of its arte rial supply, and the corresponding venous system has generally been assumed to be comparable. Because this donor site has become increasingly versatil e, a detailed anatomic study that would verify this latter assertion should be important. Therefore, venous mapping specifically of the peroneal venae comitantes was completed in 29 fresh lower limbs. In every specimen, paire d venae comitantes of large caliber indeed paralleled the course of the per oneal artery. hll were of quality satisfactory for microanastomoses, which should provide reassurance that preoperative evaluation of the peroneal ven ous system is not routinely indicated. However, anatomic variations proved to be the norm. The two venae comitante s did not necessarily coalesce into a single common peroneal vein [6 of 29 (21 percent)]. Usually, the lateral peroneal vein was the larger and contin ued proximally either alone (17 percent) or as the common peroneal vein (66 percent) to form the lateral tibioperoneal vena comitans. Thus, the venous pedicle of a fibula flap could be lengthened up to its confluence with the popliteal vein, a maneuver that potentially could obviate the need for a v ein graft at least on the venous side. Although anomalies of the peroneal artery could preclude use of the fibula altogether, there appeared to be no such contraindications from a venous st andpoint, despite the fact that the venous anatomy was unique in every indi vidual. Some important similarities in patterns, though, do exist. For exam ple, a common peroneal vein was formed by the juncture of the lateral peron eal vein and some combination of branches joining the lateral posterior tib ial vein and medial peroneal vein in 63 percent of all limbs. Because excep tions are the rule, the choice of donor vein and venous pedicle length best remains an intraoperative decision dependent on the presenting anatomy.