SLR - April 2019 - Tyler Gloschat
Reference: Troisi, L., Wright, T., Khan, U., Emam, A., & Chapman, T. (2018). The Distally Based Peroneus Brevis Flap: The Five-Step Technique. Annals of Plastic Surgery,272–276.Scientific Literature Review
Reviewed By: Tyler Gloschat, DPM
Residency Program: Northwest Medical Center, Margate, FL
Podiatric Relevance: When bone or metal hardware is exposed, there are few options to provide quick reliable coverage. One option is a free or rotational muscle flap. Within the scope of podiatry, there are relatively few available rotational muscle flaps. It is common to provide coverage of lower-extremity wounds with free flaps, such as the latissimus dorsi or vastus lateralis. The distally based pedicled peroneus brevis flap is useful for coverage of defects to the distal 1/3 of the lateral or posterior aspect of the leg. The authors of this study developed a five-step technique to harvest the distally based pedicled peroneus brevis flap.
Methods: The authors present a case series of patients where a five-step technique for harvesting and employing a distally based pedicled peroneus brevis muscle flap was employed. The flap was used to cover defects of the lateral aspect of the distal 1/3 of the leg. A total of 11 patients underwent surgical correction of nonhealing wounds using this technique, starting in May 2015. Ten patients had a defect on the ankle and lateral ankle, while one patient had a defect over the Achilles tendon. Information collected included sex, age, defect location, indication, complications and follow-up in months.
Results: Eleven patients underwent the proposed procedure. An average defect of 102 cm^2 was covered ranging from 28 cm^2 to 188 cm^2. All defects were located on the lateral aspect of the distal 1/3 of the leg except one, which was located over the Achilles tendon. Nine of the 11 defects were caused by infected metalwork, one of the 11 was a nonhealing wound and one of the 11 was an open ankle fracture dislocation. There were zero instances of the flap failing. Partial loss of the skin graft covering the flap occurred in two patients who healed with dressings. Average follow-up was five months with a range of one month to 13 months.
Conclusions: The distally based pedicled peroneus brevis is a valid option to cover small- to medium-sized defects of the lateral aspect of the distal 1/3 of the leg. The flap is thin, robust and has consistent anatomical vascular supply. The morbidity to the patient is very low if the peroneus longus is left intact. This modality in the past has been underutilized due to inexperience. This study provides a five-step technique that is “safe, reliable and reproducible.”