Reverse Peroneal Artery Flap for Large Heel and Sole Defects: A Reliable Coverage

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Reconstructing large soft tissue defects in the ankle and foot presents significant challenges.
• While reverse sural and free flaps have been used, their success rates vary.
• The reverse peroneal artery flap (RPAF) emerges as a reliable alternative, potentially avoiding microvascular repair.

Purpose of the Study:

• To evaluate the reliability and efficacy of the pedicled reverse peroneal artery flap (RPAF) for reconstructing large soft tissue defects of the heel.
• To assess the outcomes of RPAF in a clinical setting, focusing on flap survival and donor site complications.

Main Methods:

• A cohort of ten patients with large heel defects underwent reconstruction using the pedicled reverse peroneal artery flap (RPAF).
• The flap's inset was completed 18-21 days post-primary surgery.
• The mean age of the patient cohort was 45 years.

Main Results:

• All ten RPAF reconstructions demonstrated complete flap survival.
• No instances of marginal necrosis were observed.
• Minor donor site issues occurred in two patients but were resolved with conservative treatment.

Conclusions:

• The reverse peroneal artery flap (RPAF) is a highly reliable option for covering extensive soft tissue defects on the heel and sole.
• This technique enables reconstruction of large defects without requiring microvascular surgery or compromising major foot vessels.
• Experience with perforator flaps and free fibula flaps facilitates the execution of the RPAF.