Pedicled Peroneus Brevis Muscle Flaps As An Alternative to Fasciocutaneous Rotational Flaps For Lower Extremity Soft Tissue Defects

Abstract

OBJECTIVE: To report our experience using a peroneus brevis flap for soft tissue defects of the distal third of the tibia, ankle, and hindfoot in resource challenged environments. METHODS: Design: Retrospective review Setting: Rural outpatient surgical facility in Honduras Patient Selection Criteria: Patients who sustained tibia, ankle, or hindfoot fractures or traumatic degloving, with critical sized soft tissue defects treated with either a proximally based or distally based pedicled peroneus brevis flap (PBF) to achieve coverage of the middle and distal third of the leg, ankle, and/or hindfoot. Outcome Measures and Comparisons: Flap healing, complications and re-operations. RESULTS: 23 patients, four with proximally based and 19 with distally based PBF flaps were included. The mean patient age was 37.3 (SD = 18.3; range 18-75 years). Duration of follow up averaged 14.7 months (SD = 11.4; range 4-46). The PBF successfully covered the defect without the need for additional unplanned surgical flap coverage in all but two patients. Thirty percent of the PBFs received a split thickness skin graft, while the remainder granulated successfully without skin graft. Four flaps were partially debrided without additional flap mobilization, while one flap was lost completely. Ten patients had successful re-elevation of their flaps for secondary procedures such as implant removal, spacer exchange, deep debridements, and bone grafting. All donor site incisions healed without complication. CONCLUSIONS: The pedicled peroneus brevis flap allows coverage of distal leg, ankle, and hindfoot wounds using muscle in patients who may otherwise require free tissue flaps or transfer to another institution for coverage. Peroneus brevis flaps can be learned and implemented without the use of microvascular techniques.