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Related Experiment Video

Updated: Nov 2, 2025

A Reliable Porcine Fascio-Cutaneous Flap Model for Vascularized Composite Allografts Bioengineering Studies
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The Reverse Peroneus Brevis Flap for Preventing Major Level Amputation in Multimorbid Patients.

Christopher Bibbo, Jeremy Dubin1, Deepak V Patel

  • 1Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD.

Annals of Plastic Surgery
|June 11, 2025
PubMed
Summary
This summary is machine-generated.

The distally based reverse peroneus brevis muscle flap offers a viable first-line option for foot and ankle soft tissue coverage in high-risk patients. This muscle flap achieved an 83% limb salvage rate, demonstrating its effectiveness in preventing major amputations.

Keywords:
amputationhigh-risk patientsmultimorbid patientsperoneus brevis flapsoft tissue

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Area of Science:

  • Orthopedic Surgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Free tissue transfers often overshadow simpler local rotation flaps for foot and ankle soft tissue coverage.
  • The distally based reverse peroneus brevis muscle flap presents a less complex alternative for reconstruction.
  • High-risk, medically complex patients often face major amputation for lower extremity defects.

Purpose of the Study:

  • To evaluate the efficacy of the distally based reverse peroneus brevis muscle flap as a primary surgical option.
  • To assess flap survival and limb salvage rates in medically high-risk patients undergoing foot and ankle reconstruction.
  • To identify risk factors associated with flap complications in this patient cohort.

Main Methods:

  • A single surgeon's experience with the distally based reverse peroneus brevis muscle flap was retrospectively reviewed.
  • Doppler examination was used for pre-operative and intra-operative flap assessment; angiography was not performed.
  • Data collected included patient demographics, medical comorbidities, injury details, flap characteristics, and outcomes.

Main Results:

  • Complete flap survival was achieved in 75% of patients, with 14% experiencing partial flap necrosis.
  • Smoking and uncontrolled diabetes (hemoglobin A1c ≥6.5) were significantly associated with flap complications.
  • An overall limb salvage rate of 83% was achieved at a mean follow-up of 6.9 years.

Conclusions:

  • The distally based reverse peroneus brevis muscle flap is a suitable first-line treatment for foot and ankle soft tissue defects in high-risk patients.
  • This flap offers a valuable alternative to major amputation for complex lower extremity injuries in medically compromised individuals.
  • Careful patient selection and management of comorbidities like smoking and diabetes are crucial for optimizing outcomes.