{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T20:20:00Z","timestamp":1785874800188,"version":"3.56.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T00:00:00Z","timestamp":1639353600000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Complex orthoplastic lower limb trauma in individuals with multiple injuries requires considerable resources and interdisciplinary collaboration for good outcomes. We present the first reported end-to-side free flap microanastomosis for lower limb trauma reconstruction involving a peronea arteria magna without radiographic collaterals.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 55-year-old Caucasian gentleman involved in road traffic collision sustained an open tibial fracture on the anteromedial distal third of the left lower leg with local degloving and a subtotal right foot and ankle degloving. Both injuries were reconstructed with free tissue transfer. A left lower limb peronea arteria magna successfully received a free gracilis muscle flap by end-to-side microanastomosis and perfusion of the foot was preserved. This rare anatomical variant and its anatomy is reviewed, as well as a description of the suggested preoperative planning and technique for reconstruction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Successful free flap reconstruction may be performed to a lower limb with a peronea arteria magna recipient as the lone vessel supplying the foot in trauma, although preoperative counseling of the risks, benefits, and options are essential.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level V, case report<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-03133-5","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T16:02:52Z","timestamp":1639411372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Free gracilis end-to-side microanastomosis to a peronea arteria magna: a case report"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8939-1276","authenticated-orcid":false,"given":"Dallan","family":"Dargan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3832-0619","authenticated-orcid":false,"given":"Raghuram","family":"Lakshminarayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7717-3426","authenticated-orcid":false,"given":"Cher Bing","family":"Chuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,13]]},"reference":[{"key":"3133_CR1","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1002\/micr.30016","volume":"36","author":"AK Abou-Foul","year":"2016","unstructured":"Abou-Foul AK, Borumandi F. Anatomical variants of lower limb vasculature and implications for free fibula flap: systematic review and critical analysis. Microsurgery. 2016;36:165\u201372.","journal-title":"Microsurgery"},{"key":"3133_CR2","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1097\/00000658-198912000-00014","volume":"210","author":"D Kim","year":"1989","unstructured":"Kim D, Orron D, Skillman JJ. Surgical significance of popliteal arterial variants. A unified angiographic classification. Ann Surg. 1989;210:776.","journal-title":"Ann Surg"},{"key":"3133_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-80508-0","volume-title":"Arterial variations in man: classification and frequency","author":"H Lippert","year":"1985","unstructured":"Lippert H, Pabst R. Arterial variations in man: classification and frequency. Munchen: J.F. Bergmann Verlag; 1985."},{"key":"3133_CR4","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1055\/s-2005-922432","volume":"21","author":"G Rosson","year":"2005","unstructured":"Rosson G, Singh N. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg. 2005;21:533.","journal-title":"J Reconstr Microsurg"},{"key":"3133_CR5","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1002\/micr.22406","volume":"36","author":"EH Cho","year":"2016","unstructured":"Cho EH, Garcia RM, Pien I, Kuchibhatla M, Levinson H, Erdmann D, Levin LS, Hollenbeck ST. Vascular considerations in foot and ankle free tissue transfer: analysis of 231 free flaps. Microsurgery. 2016;36:276\u201383.","journal-title":"Microsurgery"},{"key":"3133_CR6","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1097\/00006534-200002000-00031","volume":"105","author":"BS Lutz","year":"2000","unstructured":"Lutz BS, Siemers F, Shen Z-L, Machens H-G, Wippermann B, Berger A. Free flap to the arteria peronea magna for lower limb salvage. Plast Reconstr Surg. 2000;105:684\u20137.","journal-title":"Plast Reconstr Surg"},{"key":"3133_CR7","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1055\/s-0030-1270531","volume":"27","author":"BB Rahmel","year":"2011","unstructured":"Rahmel BB, Snow TM, Batstone MD. Fibular free flap with arteria peronea magna: the role of preoperative balloon occlusion. J Reconstr Microsurg. 2011;27:169\u201372.","journal-title":"J Reconstr Microsurg"},{"key":"3133_CR8","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s00238-020-01673-5","volume":"44","author":"NM Betar","year":"2020","unstructured":"Betar NM, Subramaniam SS, Borgna SC. Fibula free flap with type IIIB popliteal artery branching: a case report and recommendations. Eur J Plast Surg. 2020;44:285\u20138.","journal-title":"Eur J Plast Surg"},{"key":"3133_CR9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1002\/micr.30327","volume":"39","author":"A Bulla","year":"2019","unstructured":"Bulla A, Bolletta A, Fiorot L, Maffei M, Bandiera P, Casoli V, Montella A, Campus GV. Posterior tibial perforators relationship with superficial nerves and veins: a cadaver study. Microsurgery. 2019;39:241\u20136.","journal-title":"Microsurgery"},{"key":"3133_CR10","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1007\/s00276-008-0338-1","volume":"30","author":"W Jung","year":"2008","unstructured":"Jung W, Oh CS, Won HS, Chung IH. Unilateral arteria peronea magna associated with bilateral replaced dorsalis pedis arteries. Surg Radiol Anat. 2008;30:449\u201352.","journal-title":"Surg Radiol Anat"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-03133-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-021-03133-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-03133-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T16:06:19Z","timestamp":1639411579000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-03133-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3133"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-03133-5","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"16 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This is an observational case report. Ethical approval was not required as no deviation from standard practice occurred. This study protocol conforms with the tenets of the Declaration of Helsinki. Written informed consent was obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare that they have no conflict of interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"601"}}