Proximal peroneal perforator flap, cadaveric study, and clinical applications for shallow defect reconstructions

Area of Science:

• Microsurgery and reconstructive surgery
• Anatomy and surgical applications of perforator flaps

Background:

• The peroneal artery perforator flap is valuable for thin, pliable tissue transfer, particularly for shallow defects in the hands and feet.
• Limited understanding of proximal peroneal artery perforator anatomy and its relationship with the common peroneal nerve (CPN) necessitates further investigation.

Observation:

• Dissection of 20 lower leg specimens revealed perforators in 90% of cases, averaging 101 mm from the fibular head with a mean length of 55 mm.
• Perforator courses were either septocutaneous (45%) or intramuscular (55%), with some arising from vessels other than the peroneal artery.
• Clinical application in six patients demonstrated successful reconstructions of hand and foot defects using thin, pliable flaps without complications.

Findings:

• Proximal peroneal artery perforator flaps offer a reliable pedicle for versatile tissue transfer.
• Perforator anatomy is consistently at a safe distance from the CPN, despite variations in source vessels (anterior tibial or popliteal artery).
• The flap is effective for shallow defect reconstruction in hands and feet, requiring no secondary debulking procedures.

Implications:

• The study supports renaming the flap to 'proximal peroneal perforator flap' due to variable source vessels.
• This flap provides a dependable option for complex reconstructions, enhancing surgical outcomes.
• Further research into perforator flap variations can optimize reconstructive techniques.