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?

作     者：Raymund E.Horch Ingo LudoIph Marweh Schmitz Anja M.Boos UIrich Kneser Justus P.Beier Andreas Arkudas1 

作者机构：Department of Plastic and Hand SurgeryUniversity Hospital ErlangenFriedrich-Alexander University Erlangen-Nuernberg FAUErlangen D-91054Germany Department of HandPlastic and Reconstructive Surgery-Burn Center-BG Trauma Center LudwigshafenDepartment of Plastic SurgeryUniversity of HeidelbergLudwigshafen D-67071Germany Department of Plastic Hand and Burn SurgeryUniversity Hospital RWTHAachen D-52074Germany 

出 版 物：《Plastic and Aesthetic Research》 (整形与美容研究（英文版）)

年 卷 期：2018年第5卷第7期

页      面：26-34页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Free flaps peroneus brevis muscle flap lower extremity reconstruction 

摘      要：Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add healthy tissue especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical centres. Nevertheless, in some instances pedicled flaps may have indications when free flaps are not suitable. Methods: The distally based peroneus brevis flap is harvested from the lateral compartment of the leg based on the distal perforating arterial supply and covered with split skin. Results: We performed a total of 69 peroneus flaps between 2003 and 2017. Minor flap necroses at the distal tip were noted in 8% of the peroneus brevis reconstructions. Total flap loss occurred in 1 peroneus flap. Defect etiology and patient age were not associated with surgical outcome. Conclusion: While nowadays the first choice of lower extremity reconstruction is an appropriate free flap solution,the peroneus brevis muscle flap can also be seen as a valuable tool to reconstruct small to medium sized defects at the ankle, distal tibia, and the heel with an acceptable donor site morbidity. Despite the easily available variety of free flaps to achieve this purpose, still proper indications remain where a local flap can be a viable option in the hand of experienced plastic surgeons. However, caution is advisable in patients with peripheral arterial occlusive disease or venous insufficiency.