The split peroneus muscle flap: a new flap for lower leg defects

The peroneus brevis tendon mechanism is more effective than the peroneus longus mechanism in rotating the navicular externally and the calcaneus into valgus. A longitudinal vertical split of the peroneus brevis muscle is a new technique that allows coverage of the fibular and pretibial region defects without impairing the muscle function. The essential features of the flap are: transposition of the muscle without disinsertion, splitting the muscle longitudinally along a distinct anatomical plane, and preservation of the anatomical continuity of the muscle. The flap has been tested on seven male patients who had sustained open fractures of the ankle region with metal implant exposure of the fibula. The size of the flap ranged from 13x6cm to 15x7cm (mean 13.8x6.5cm). The soft tissue defects were located between the pretibial region and the lateral malleolus. Their ages ranged from 22 to 39 years (mean 28.7 years). Follow up was from 3 to 24 months (mean 14.5 months). The technique of split peroneus muscle flap was applied successfully in all patients. There was no necrosis of the muscle flap and stable wound healing was achieved. The cosmetic result was good and the function of the muscle was preserved. The advantages offered by this new flap include: technical simplicity, reliability, and the allowance of future use of other local skin and muscle flaps. With the help of this new technique it is possible to cover defects of up to 20x7cm and to preserve the muscle function.