Possibility of venous return through bone marrow in the free fibular osteocutaneous flap

The authors report a case of a free fibular graft that was successful as a result of venous return delivered through the bone marrow. A 26-year-old ma n underwent reconstruction of the left tibia and a soft-tissue defect of th e lower leg. A free vascularized fibular bone and skin flap was elevated. T he fibular vessels were anastomosed to the dorsalis pedis vessels. The elev ated fibular bone was fixed to the tibia. The next day, reanastomosis was n ecessary because of venous thrombosis. However, the fibular vein rethrombos ed, but blood flow was ascertained by Doppler flowmetry, with darker blood flow being recognized from the edge of the flap. Four days after surgery, t he skin color gradually improved, and the flap had almost completely taken. On retrospective evaluation, the authors concluded that this flap succeede d because venous return was routed through the bone marrow in the free fibu lar graft.