Extended Scope of the Use of the Peroneal Perforator Flap in Lower Limb Reconstruction

The advantages of the peroneal perforator flap include a short harvesting time, thinness, and pliability. Due to the presence of a short pedicle and small vessel diameter, without peroneal vessel sacrifice, this flap is commonly used for distal limb reconstruction, but is rarely used for knee and proximal and middle lower leg reconstruction. We describe our experience with the application of a versatile peroneal perforator free flap for knee and proximal and middle lower leg reconstruction through supermicrosurgery.

Between October 2010 and August 2014, 22 patients with small-to-medium-sized defects on their knee and proximal and middle lower leg underwent reconstruction surgery using a peroneal perforator free flap. End-to-end anastomosis using a supermicrosurgery technique is often necessary, given the extremely small perforator vessel caliber (often less than 1.0 mm).

The flap sizes ranged from 5 × 3 to 14 × 5.5 cm. The mean duration required for recipient perforator dissection was 30 minute, mean pedicle length was 4.5 cm, and mean duration required for flap harvesting was 31 minutes. Overall, 20 patients showed no complications; 1 case each showed total and partial necrosis.

The use of a peroneal perforator free flap for knee and proximal and middle lower leg reconstruction, via supermicrosurgery, for small- and medium-sized defects had several advantages, including the short duration required for flap harvesting and securing the recipient vessel, and the avoidance of damage to a main artery. Moreover, the thinness and pliability of the flap ensured the absence of contour deformity and tissue defect mismatches.