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Anatomical variant of physeal blood supply to the fibula
  1. Angelos Mantelakis1,
  2. Maleeha Mughal1,
  3. Julian Man2 and
  4. Paul Roblin1
  1. 1Plastic Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  2. 2King's College London, London, UK
  1. Correspondence to Dr Angelos Mantelakis; aggelosmantelakis{at}


Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to growth suppression in extremity reconstruction. We report a case of an anatomical variant to the epiphysial blood supply that has never been reported in literature. A 6-year-old girl underwent a free vascularised fibula flap for reconstruction of her right humerous following osteosarcoma resection. While identifying and dissecting the recurrent epiphysial branch, a large branch from the peroneal artery was identified which directly entered the head of the fibula. No dominant supply from the anterior tibial (AT) vessels to the head of the fibula was seen. This led to the need for a bipedicled flap with diaphyseal supply from the AT vessels and the epiphysial transfer based on the peroneal artery. The patient made an uneventful recovery from the procedure. The same technique may be used by surgeons that may encounter this unique variant in clinical practice.

  • orthopaedic and trauma surgery
  • paediatric surgery
  • plastic and reconstructive surgery
  • surgical oncology

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  • Contributors AM: contributed to the design of the manuscript, writing of the manuscript and approved its final version. JM: contributed to the writting of the manuscript, literature review, reviewed the final manuscript and approved its final version. MM and PR: was involved in the patients care, contributed to the conception of this case report as well as supervised the writing of the manuscript, revising and approving its final form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.