The Reverse Peroneus Brevis Flap for Preventing Major Level Amputation in Multimorbid Patients

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.