Reconstruction of near total glossectomy and segmental mandibular defect with free fibula flap in Type IIIA popliteal artery branching variant: A case report and review of popliteal artery branching variations

Free fibula flap (FFF) is considered one of the viable options for complex mandibular defect reconstruction. Some branching variations of the popliteal artery contraindicate its harvest. Very few reports related to FFF harvest in Kim's type IIIA exist. A case of carcinoma tongue with mandibular involvement was planned for reconstruction with FFF. Intraoperative exploration showed absence of posterior tibial artery (PTA). A short segment of the fibula with a short pedicle was harvested. A reverse saphenous vein graft (RSVG) was utilized to reconstruct the dominant peroneal artery (dPR) and create an arterio-venous (A-V) loop in the neck. Post-operative CT angiography (CTA) was done to confirm the anomaly. Post-operative pedal circulation was well maintained. No posterior compartment muscle necrosis was observed. CTA confirmed Kim's Type IIIA in the right leg and Type IIIC in the left. At three weeks the flap was viable and underwent revision surgery. In the Type IIIA popliteal branching pattern, mandible reconstruction could be successfully performed with FFF using vein graft without any ischemic complications in the flap or leg and foot. •Composite Oro-mandibular defect reconstruction by free fibula flap.•Free fibula flap harvest in cases where posterior tibial artery is absent or hypoplastic.•Review of different popliteal artery branching pattern and complications associated with FFF harvest.•Saphaneous vein harvest and reconstruction of dPR using reverse saphenous vein graft.