The distally based peroneus brevis muscle flap—clinical series and review of the literature

Abstract

The distally pedicled peroneus brevis muscle flap is rarely used for defect coverage in the distal lower leg. The purpose of this article was to present our clinical series and provide a review of the literature to analyze the overall complication rates and safety of this flap. In our clinical series of 10 patients undergoing reconstruction with the flap, one necrosis of the distal half of the flap and one necrosis of a skin graft occurred. Our review of the literature identified 192 patients undergoing reconstruction with distally pedicled peroneus brevis flaps. The overall complication rate was 41.6%. Typical indications, complications, advantages and disadvantages to alternatives are discussed. The distally pedicled peroneus brevis flap is an interesting option for soft tissue coverage in the distal lower leg. The donor site can always be closed primarily, the anatomy is constant and complication rates are comparable to alternatives in this region like the distally based sural fasciocutaneous flap.

Postoperative negative pressure therapy significantly reduces flap complications in distally based peroneus brevis flaps: Experiences from 74 cases

“…The muscle flap provides constant vascularity and sufficient tissue for coverage of small defects [11]. However, the rate of re-operations due to skin graft necrosis, partial or even complete flap loss is considered high [5,8]. Schmidt and Giessler presented their experiences with 109 peroneus brevis flaps, which were distally based in 98 cases [4].…”

“…However, the rate of revisional surgery for minor problems (e.g. partial skin graft loss) or major problems (partial or complete flap loss) is high [8]. Reasons might be venous congestion with concomitant oedema of the flap and shear stress, eventually resulting in partial or complete flap loss [4,8].…”

A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles

“…Ideally, when tissue is lost, similar tissue should be used for reconstruction. Traditional treatment is to use pedicle skin flaps or local transposition flaps to repair soft tissue defects, but availability of local donor tissues is quite limited, especially at the foot and ankle [8][9][10][11]. Moreover, when bone or tendon is exposed with gross tissue loss, local flaps cannot provide coverage.…”

“…Moreover, when bone or tendon is exposed with gross tissue loss, local flaps cannot provide coverage. An alternative is to use free flaps [10][11][12][13][14]. Our goals for reconstructive surgery were to provide: (1) a tendon reconstruction that could withstand the mechanical and shear forces required for normal function, such as standing, walking and running; (2) vascularised soft tissue that could fill a cavity, cover a wound and protect healing and smooth movement of tendons; and (3) durable skin coverage for an injured foot to wear shoes and move [15].…”

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

“…Free flap transfer has become a routine method in high volume centers and allow free tissue transfer even to the distal lower extremity with a successful closure in more than 90%-95%, depending on the comorbidities and local and systemic conditions. This does not preclude the remaining interest in local flaps to solve the problem of small to medium-sized defects in this critical anatomical region [59,60] .…”