The muscular and the new osteomuscular composite peroneus brevis flap: experiences from 109 cases

Pedicled peroneus brevis muscles are proven flaps for defect coverage around the ankle, foot, and distal lower leg. Some of these defects--such as postosteitic hollowed out calcaneal bones--may profit from a simultaneous vascularized bone transplantation. The authors' experiences with 109 successive muscular and newly developed osteomuscular peroneus flaps are outlined for small to medium combined defects in this region.

One hundred nine patients with various soft-tissue and skeletal defects underwent reconstruction with proximally (n = 10) or distally pedicled (n = 98) or free microvascular transplanted (n = 1) peroneus brevis flaps. Eight patients received a composite flap of the peroneus brevis muscle with an attached lateral split fibula segment.

In 72.5 percent of the cases, a stable defect closure was achieved without significant secondary procedures. In 16.5 percent, further operations such as secondary wound closure or flaps were necessary, most often because of the avascular loss of the 1 to 3 cm of the distal flap tip. Nine flaps (8.3 percent) were lost completely. Seven of eight osteomuscular flaps demonstrated stable bony healing, and full weight bearing was achieved. No relevant donor-site complications were seen.

The peroneus brevis is a valuable flap for defect closure around the ankle and lower leg. It can be harvested together with a vascularized split fibula segment, representing a simple alternative to several free composite flaps. Its complication rate can be lowered significantly if the proximal 3 cm of the muscle origin (i.e., the flap tip in distally pedicled flaps) is discarded during dissection and delicate hemostasis is performed.