Distally based peroneus brevis muscle flap in reconstructive surgery of the lower leg: Postoperative ankle function and stability evaluation

Fulvio Lorenzetti, Davide Lazzeri, Luca Bonini, Giordano Giannotti, Nicola Piolanti, Michele Lisanti, Marcello Pantaloni
Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2010, 63 (9): 1523-33

BACKGROUND: Defects of the distal third of the lower leg with exposed tendons or bone require either local or free flap coverage. Several flaps have been developed, and the distally pedicled peroneus brevis muscle flap has been proven to be a valid local flap alternative.

PATIENTS AND METHODS: Peroneus brevis muscle is dissected from the lateral surface of the fibula from proximal to distal, but no further than approximately 3-6 cm proximally to the lateral malleolus, where the most distal vascular pedicle from the peroneal artery enters the muscle consistently. This allows the muscle to be transposed to more distal lesions. The muscle is then covered with meshed split-skin graft. Between 2002 and 2008, 10 patients with defects of the lower leg in the distal lower third have been treated using this muscle flap. The defects were located over the Achilles tendon, the medial and lateral malleolar, the anterior region of the ankle and the heel area. Each patient was examined through assigning clinical demerit points according to a modified Weber scale, and through Olerud-Molander ankle score to analyse postoperative ankle stability and functionality after reverse peroneus brevis flap reconstruction of the defect.

RESULTS: All flaps survived completely, and no secondary local flap was required. In our experience, no complication or patient discomfort was noted. Donor-site morbidity was acceptable and restricted to the scar in the lateral lower leg. As demonstrated by the two score evaluations, the functions of foot eversion and plantar flexion as well as ankle functionality and stability were maintained due to preservation of peroneus longus muscle.

CONCLUSION: The reverse peroneus muscle flap is ideally suited for small-to-moderate defects of the distal third of the lower leg. This flap offers a convincing alternative for covering defects in the distal leg region. Its arc of rotation allows coverage of more anterior defects of the ankle, of defects of the Achilles tendon and of the heel area as well as of lateral and medial malleolus areas. It is simple to raise and is often transposed easily within the wound without further dissection. As long as the peroneus longus is preserved, ankle instability is not expected.

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