The Versatility of the Distally Based Peroneus Brevis Muscle Flap in Reconstructive Surgery of the Foot and Lower Leg

Abstract

Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based peroneus brevis muscle flap for the treatment of 15 patients with osteomyelitis (n = 5), melanoma (n = 1), Achilles tendon defects (n = 6), posttraumatic bone defects (n = 2), and chronic diabetic heel ulcer (n = 1). The size of the defects ranged from 6 to 60 cm. All defects were covered successfully without major complications by the muscle flap. The distally based peroneus brevis muscle represents a very reliable flap for coverage of small and moderate defects of the medial and lateral malleolus, the Achilles tendon, and the heel area. This flap offers a convincing alternative for covering defects in the distal leg region and is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.

Complications in ankle fracture surgery

“…The use of a distally based peroneus brevis flap was reported a decade later by Eren et al (Eren et al 2001). Elevation of the distally based peroneus flap does not require elaborate microsurgical skills (Yang et al 2005, Bach et al 2007, Kneser et al 2011, and successful results for soft-tissue reconstruction of the ankle have been reported with this flap (Koski et al 2005, Yang et al 2005, Bach et al 2007, Lorenzetti et al 2010, Kneser et al 2011. Distally based peroneus brevis flap has been recommended as a first-line procedure for small-to medium-sized defects in malleolar region, since patients managed with sural flaps have higher complication rates (Kneser et al 2011).…”

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?

“…Various modifications of the sural and peroneusbrevis flaps have been described to optimize the outcome and minimize complications [63][64][65][66][67] . The distally based peroneus brevis flap has been described as an efficient tool for the reconstruction of the distal lower leg, ankle, Achilles tendon and proximal foot region [4,65,[68][69][70][71][72][73] . This flap can be indicated to cover exposed vessels, bones, tendons, and internal fixation hardware.…”

“…This flap has therefore been successfully applied by various authors to reconstruct the distal lower leg, ankle and Achilles region [4,[27][28][29] . We discuss the peroneus brevis flap as a part of the surgical armamentarium and hence its specific technical aspects in this paper.…”

“…A variety of available options have been described for this problem zone [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] . However, when either the local conditions or other obstacles including systemic diseases, that limit an extended operation time or missing microsurgical expertise are hindrances to closure, local flaps may be a solid option.…”

Continuous local intraarterial infusion of anticoagulants for microvascular free tissue transfer in primary reconstruction of the lower limb following resection of sarcoma

“…The reconstruction of the defects at the lower limb has been extensively studied, with multiple reports. [1][2][3] Although the use of local flap is feasible to cover the defects when the size is small or medium, 4,5 it might be difficult to cover large defects at the lower limb using the local flap. Therefore, microsurgical free tissue transfer would be chosen over pedicled local flaps to reconstruct the large defects or composite tissue defects of lower limb.…”