Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Ramesha Kunchekoppal Thammannagowda,Shankarappa Mudukappa,Abhishek Vijayakumar,Ghuge Ashish,Dehpande Pushkar

doi:10.1155/2014/969420

Ramesha Kunchekoppal Thammannagowda, Shankarappa Mudukappa + Show 3 more

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https://doi.org/10.1155/2014/969420

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Abstract

Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Defects at this site will often require flap cover. Free flap is ideal for these defects and gives good results but with its own limitations. The reverse sural artery flap (RSAF) and distal peroneus brevis flap (DPBF) have gained popularity for lower third leg defects among surgeons. We did a retrospective study on 64 patients admitted between 2011 and 2013 with posttraumatic moderate size defects of lower one-third leg who underwent RSAFs and DPBFs. These patients were followed up in the immediate and late postoperative period for complications and outcome assessment. The average surface area covered by DPBF was 27 cm2 and by RSAF was 38 cm2. Both flaps gave a good functional outcome. DPBF has better aesthetic appearance at donor site and recipient site, with the advantages of ease of surgery, speedy recovery, less hospital stay, and no donor site morbidity; DPBFs appear to be a preferred choice for moderate size lower third leg defects. RSAFs should be chosen over DPBFs for defects in medial malleolus and larger size defects.

Highlights

Complex wounds and soft tissue defects in the distal third of the leg and ankle remain a difficult problem to solve
Patients of distal peroneus brevis flap (DPBF) covered a defect with mean area of 27 cm2 with a range of 20 cm2 to cm2 while reverse sural artery flap (RSAF) group covered a mean defect area of cm2 (Table 1)
Main advantage that we found with DPBF was shorter operative time and shorter hospital stay which is of importance in a high volume trauma centre with limited beds

Summary

Introduction

Complex wounds and soft tissue defects in the distal third of the leg and ankle remain a difficult problem to solve. Several reconstructive procedures have been proposed to repair soft tissue defects in these regions, including local cutaneous flaps, pedicled fasciocutaneous flaps, pedicled muscle flaps, and free flaps. An ideal flap should be technically easy to harvest and reliable and have a high success rate with minimal donor site morbidity. Free-tissue transfer could be the treatment of choice, but it requires a team approach and accompanies long operative time, donor morbidity, and a risk of complete failure. Nonavailability of microsurgical expertise and facility at peripheral centers, high volume trauma centers, the cost involved, and, sometimes, the patient-related factors may preclude the option of free flap. Free-tissue transfer plays an important role in limb salvage, a thorough understanding and applications of regional flap designs can sometimes provide easier and more cost-effective alternatives for soft tissue coverage of the injured lower extremity [1]. Two flaps have emerged popular among surgeons due to their versatility, ease of mobilization, and reliability, the reverse sural artery flap and peroneus brevis flap

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