The Distally Pedicled Peroneus Brevis Muscle Flap: A New Flap for the Lower Leg

Abstract

Defects of the skin and soft tissue in the region of the lateral malleolus of the ankle and the Achilles tendon, resulting in exposed bone, tendons, or osteosynthetic material, cannot be covered with free skin transplants. Local or free flaps must be employed. The authors present the construction of a peroneus brevis muscle flap with a distal pedicle as a useful alternative. Between 1993 and 1999, distal pedicled peroneus brevis muscle flaps were used in 19 patients with various types of defects. During construction of the flap, both the long peroneal muscle and the peroneal artery remained intact. In the region of the distal third of the fibula, consistently arranged branches run from the artery into the muscle, and these form the distal pedicle. The proximal portion of the muscle can be transposed distally and easily extends to the tip of the fibula and the attachment of the Achilles tendon to the calcaneus. Primary healing occurred in 16 patients undergoing flap construction. Donor-site morbidity was mostly limited to the donor-site scar. The distally pedicled peroneus brevis muscle flap is a reliable means for covering defects in the lower leg. This form of muscle flap has not yet been described in the known literature. In the authors' opinion, this flap constitutes a logical and valuable extension of local flap procedures for plastic surgery in the distal leg region.

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

“…In 2001, Eren et al described the use of the distally based peroneus brevis flap for reconstruction around the ankle [3]. A larger series on this flap by Schmidt and Giessler [27] has been the 109 cases reported in 2010.…”

“…Distally based peroneus brevis flap was first described by Mathes and Nahai [2] and further characterized in detail by Eren et al [3] and Yang et al [4].…”

Complications in ankle fracture surgery

“…After Masquelet's detailed description of the surgical technique on a distally based sural flap, it became the workhorse in the reconstruction of the distal lower leg (Masquelet et al 1992, Vaienti et al 2012b. 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.…”

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?

“…Modifications and standardization of this flap [18] were popularized by Eren et al [26] and further propagated by others as a useful muscle flap to reconstruct small defects in the lateral distal third of the leg .…”

“…In our clinical routine it has been implemented as a workhorse for reconstructing small full thickness defects in the distal lower leg, ankle and heel [19][20][21][22][23][24] . Later papers added their experiences and highlighted the key points that need to be taken into account McHenry et al [25] and Eren et al [26] .…”