Approach and Versatility of Multiple Options to Harvest Fibular Vascularized Corticoperiosteal Flap

Successful tibial and hindfoot reconstruction requires more than technical skill; it demands a surgical strategy capable of adapting to intraoperative findings. Considering that intraoperative anatomical and vascular findings may differ from preoperative imaging, a flexible approach is essential to managing varying patient cases. Although multiple well-established fibular flap techniques currently exist, they are traditionally approached as independent procedures with separate preoperative planning and dissection approaches. Rather than preoperatively committing to 1 flap technique, our unified harvest approach enables surgeons to choose 1 of 3 proven techniques-vascularized fibula free flap, vascularized fibular medialization, and distal myocutaneous fibular flap-once intraoperative vascularity, tissue quality, and defect assessment have been made. Harvest approach is performed through a shared lateral compartment exposure alongside dual osseous windows. This approach reframes the reconstructive workflow by preserving flap commitment until intraoperative confirmation has been made. Our innovation lies not in the individual flap techniques but in the integration of all 3 into a unified harvest strategy. This approach seeks to enhance reconstructive flexibility, reducing the need for multiple plans while mitigating intraoperative risk when preoperative assumptions prove inaccurate.