Reverse peroneal flaps: two surgical approaches

The peroneal vascular pedicle supplies the posterolateral aspect of the lower limb and can be used in a reverse-flow manner to reliably cover wounds of the lower third of the leg and ankle. Two surgical approaches may be used, medial and lateral, to treat a variety of soft-tissue deficits. For the medial approach, the patient is positioned supine and the flexor hallucis longus muscle along with the peroneal vascular pedicle is raised. This easily covers medial malleolar or distal anterior tibial defects. For the lateral approach, the patient is positioned prone and a fasciocutaneous flap is dissected and can be used to cover soft-tissue defects down to the proximal foot and ankle. A total of 13 patients underwent reverse peroneal flaps with a follow-up of 6 months to 3 years. All patients healed their wounds, but there were minor wound complications in 4 patients. When used in a reverse-flow manner, the peroneal vascular system can allow for a wide variety of flap designs to treat selected patients.