Peroneal tendofascial flap: a new fascial flap for Achilles tendon coverage, a preliminary report

The tendons of the both peroneus longus and brevis muscles lie in the lateral compartment of the leg, enclosed in a fascial sheath. This sheath has been dissected off the tendons in three cases and opened longitudinally forming a sheet of vascularised fascia proximally based and continuous with the peroneal muscles. These sheets of 6 x 12 cm dimensions have been successfully transposed with split skin graft to cover an exposed Achilles tendon. In another case, the peroneus brevis muscle and the opened fascial sheath of the peroneus longus tendon forming one sheet was used to cover a defect over the Achilles tendon 10 cm above the heel. This 'tenofascial flap' offers regional tissue to solve the difficult lower third leg defects especially those of Achilles tendon exposure, as it is thin, pliable, allows gliding of the tendon underneath it and vascular enough to sustain a durable skin graft.