Peroneus Brevis Muscle Flap Research Articles

Distally based peroneus brevis flap: Reconstruction of complex soft-tissue defects with bony infection of the lateral malleolus

BackgroundManaging wounds of the lateral malleolus is challenging owing to limited nearby tissues and possibly injured or inadequate vessels for free flaps, especially in case of underlying infections. Moreover, free flaps require specialized skills and are not suitable for every patient. Therefore, identifying reliable local alternatives is crucial. This retrospective study investigated the efficacy and safety of the distally based peroneus brevis muscle flap in treating complex and infected soft-tissue defects of the lateral malleolus. Materials and methodsA retrospective medical chart review of all patients who underwent a distally based peroneus brevis muscle flap reconstruction in the context of an infected lateral malleolus defect at Geneva University Hospitals between October 2020 and January 2024 was performed. ResultsTen patients underwent lateral malleolus reconstruction using a distally based peroneus brevis muscle flap primarily to address post-traumatic infections. Flap coverage was performed within 4 weeks of infection onset for post-traumatic cases, alongside antibiotic treatment. The defects were moderate in size, with a median width of 2.5 cm and length of 5.5 cm. There were no complete or partial flap failures. All patients regained the ability to walk within 5 days after surgery. ConclusionsThe distally based peroneus brevis muscle flap was efficient in managing complex and infected soft-tissue defects of the lateral malleolus, with control of infection in all patients and minimal donor-site morbidity.

The use of peroneus brevis in lower limb reconstruction—What we have learned from 49 cases

IntroductionThere are many suitable techniques for the treatment of soft tissue defects of the lower limb. Older subjects often with multiple comorbidities, presenting with a laterally located and complex defect, can be challenging to treat. This cohort are often unsuited to long procedures or multi-stage reconstruction and so one is faced with a paucity of options. In such instances, we use the peroneus brevis (PB) muscle flap as a single stage procedure. MethodsWe performed a retrospective study evaluating the use of PB flaps in lower limb injury. Subjects were collated using a database and multiple variables were assessed including: patient demographics, comorbidities, defect size, peri-operative timings, time in theatre, use of inotropes / blood transfusion, mean hospital stay, patient morbidity / mortality, flap survival. ResultsDuring 2015–2023, 49 patients underwent lower limb reconstruction using PB muscle flaps. 42 cases involved PB and skin graft alone whilst seven were more complex requiring additional local and free tissue techniques. The most common indication (n = 28) was infection after closed fracture fixation, followed by open trauma (n = 21).Median patient age was 59 (20–93 years), and ASA grade 3. Median defect size was 4 × 7 cm (2–18 cm) and time from admission to definitive closure 4 days (0–21 days) with median time in theatre 120 min (45–520 min). 17 patients required inotropes and 13 had blood transfusion. Median length of hospital stay was 12 days (0–58 days), one patient (aged 90) died. 100 % of flaps survived and median Enneking score was 65. Heterotopic ossification was not identified in the post-operative imaging within the first year. DiscussionOur experience highlights the benefits and risks of using the PB flap and advocates it as a reliable, cost-effective, 1-stage technique for reconstructing small lateral defects in the distal third of the lower limb.

Pedicled Peroneus Brevis Muscle Flaps as an Alternative to Fasciocutaneous Rotational Flaps for Lower-Extremity Soft Tissue Defects.

To report our experience using a peroneus brevis flap (PBF) for soft tissue defects of the distal third of the tibia, ankle, and hindfoot in resource-challenged environments. Retrospective review. Rural outpatient surgical facility in Honduras. Patients who sustained tibia, ankle, or hindfoot fractures or traumatic degloving, with critical-sized soft tissue defects treated with either a proximally based or distally based pedicled PBF to achieve coverage of the middle and distal third of the leg, ankle, and/or hindfoot. Flap healing, complications, and reoperations. Twenty-three patients, 4 with proximally based and 19 with distally based PBF flaps were included. The mean patient age was 37.3 (SD = 18.3; range 18-75 years). Duration of follow-up averaged 14.7 months (SD = 11.4; range 4-46). The PBF successfully covered the defect without the need for additional unplanned surgical flap coverage in all but 2 patients. Thirty percent of the PBFs received a split thickness skin graft, while the remainder granulated successfully without skin graft. Four flaps were partially debrided without additional flap mobilization, while 1 flap was lost completely. Ten patients had successful re-elevation of their flaps for secondary procedures such as implant removal, spacer exchange, deep debridements, and bone grafting. All donor site incisions healed without complication. The pedicled PBF allows coverage of distal leg, ankle, and hindfoot wounds using muscle in patients who may otherwise require free tissue flaps or transfer to another institution for coverage. PBFs can be learned and implemented without the use of microvascular techniques. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Distally based lateral supramalleolar flap for reconstructing distal foot defects in India: a prospective cohort study.

Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

Peroneus Brevis Muscle Flap for a 20-year-old Neuroischemic Diabetic Ulcer Induced by Traumatic Injury: A Case Report Detailing the Efficacy of Advanced Combined Treatment Modalities for Chronic Wound Closure

Introduction. Peroneus brevis flaps provide a viable option to achieve soft tissue coverage in hard-to-heal lower extremity wounds, specifically those to the lateral ankle and hindfoot. Case Report. The authors present a unique case of a patient with a 20-year-old wound dehiscence complicated by osteomyelitis. The wound was a complication from a lateral extensile incision utilized during prior calcaneal open reduction and internal fixation. Due to many factors, including multiple comorbidities, the patient could not obtain complete healing despite IV antibiotics, vascular optimization, local wound care, surgical debridement, and grafting. Wound closure was ultimately achieved with a PB muscle flap. Adjunctive therapies also utilized included multilevel ring external fixation, negative pressure wound therapy, and hyperbaric oxygen therapy. On follow-up 32 months after the procedure, the patient continued to be wound free and satisfied with the results. Conclusions. This case report demonstrates the utility of PB muscle flaps for hard-to-heal lower extremity wounds in patients with comorbidities.

Surgical Outcome of Distally Based Peroneus Brevis Flap: A Retrospective Study.

Background: This study aimed to evaluate the surgical outcomes of distally based peroneus brevis muscle flap in post-traumatic lower leg defects.Methods: This is a retrospective analysis conducted from February 2017 to May 2019 including six patients who had sustained post-traumatic lower leg critical soft tissue defects and were treated with distally based peroneus brevis muscle flap and primary skin grafting.Results: In five cases, the flap was successful in providing excellent soft tissue cover to the defects addressed. Partial flap loss was seen in one patient. Skin graft partial loss was seen in three of the six patients. There was no significant donor site morbidity.Conclusions: The distally based peroneus brevis muscle flap is a safe, easy, and reliable flap option for coverage of lower leg defects. The muscle flap also thins with time to provide a good aesthetic outcome.

Surgical Exposure of the Distal Fibula to Protect the Peroneus Brevis Muscle Vascular Pedicle.

Ankle fractures are a common presentation to orthopaedic surgeons, with the lateral malleolus involved in 86% of cases. A soft tissue injury can be a concomitant feature of these injuries as a result of the primary injury or following secondary wound breakdown. The peroneus brevis muscle flap provides a reliable and robust option to cover the distal third of the lower limb. With an understanding of the anatomy and cautious dissection during periosteal elevation, the perforating vessels supplying the peroneus brevis can be preserved ensuring that a valuable reconstructive option is available.How to cite this articleIrvine E, Cochrane E, Harwood P, et al. Surgical Exposure of the Distal Fibula to Protect the Peroneus Brevis Muscle Vascular Pedicle. Strategies Trauma Limb Reconstr 2021;16(3):176–178.

Distally Based Peroneus Brevis Muscle Flap for Soft Tissue Reconstruction in Lower Third of Leg: A Case Series

Covering soft tissue defects in the distal part of leg and ankle is difficult. Most of the flaps used in reconstructing these defects are bulky and aesthetically unpleasing. The peroneus brevis muscle flap is ideal for covering these defects and providing an aesthetically better outcome. Peroneus brevis is a muscle located in the lateral compartment of the leg. It can be used for covering defects over the ankle and distal part of the leg without causing loss of function. This study was done to assess the surgical technique and clinical outcomes in the use of this muscle flap. This case series presents the authors’ experience of six cases of distally based peroneus brevis muscle flap. Three of the six patients were found to have superficial flap necrosis. Two of these three was treated with debridement and Split Skin Grafting (SSG) while one was managed conservatively with daily dressings. This flap is simple, easy to rise and useful in covering small defects of 3-4 cm width in the distal part of the leg and ankle. The donor site to be closed primarily leaving behind only a thin linear scar. Overtime the flap thins down and gives good cosmetic results. Donor site morbidity is minimal as the peroneus longus muscle is preserved and thus the function of the foot (plantar flexion and foot eversion) is intact. The distally based peroneus brevis flap is a reliable flap for covering defects over the distal one third of the leg, the upper half of the medial and lateral malleoli and the posterior aspect of the heel.

Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes

Abstract Background: In the decision-making process toward covering various Achilles' tendon region, knowledge about patient related outcomes after surgery and rehabilitation is important. Therefore, we aimed to present an overview of outcomes and select the most appropriate flaps used for covering soft tissue defects over Achilles' tendon region. Aim of Study: Study aimed to analyse and determine the suitable reconstructive surgical options for Achilles' tendon coverage and to evaluate the clinical, functional and aesthetic outcomes. Patients and Methods: Between September 2017 and December 2019, 25 patients with skin loss over Achilles' tendon region were admitted to Menoufia University Hospital and Shebin-Elkom Teaching Hospital. The soft tissue defects ranged from 3x2 to 16x12 cm. Six types of flaps were used for the coverage of concomitant skin defects. Results: There was no complete flap loss and all flaps survived. Lateral supra malleolar flap (28%) was used in seven patients, distally based peroneus brevis muscle flap (16%) in four patients, posterior tibial artery perforator flap (24%) in six patients, peroneal artery perforator flap (4%) in one patient, reversed sural artery flap (24%) in six patients, and free latissimus dorsi musculocutaneous flap (4%) in one patient. Two patients were subjected to debridement and covered with split thickness skin graft (STSG). One patient suffered from chronic ulcer formation which was covered with lateral supra malleolar artery flap. The algorithm of one-stage reconstruction was established, according to the defect size of skin. Conclusion: Perforator flaps, lateral supra malleolar artery flap, and the distally based peroneus brevis muscle flap were a suitable option for coverage of small to intermediate sized defects; reversed sural artery flap is best for coverage of moderate to large size defects and free flaps are the best choices for complex wide reconstructions.

Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients.

Reconstruction of lower extremity soft tissue defects is an exceptional surgical challenge, especially in multimorbid, elderly and severely ill patients with their thin and tense local soft-tissue conditions and increased perioperative risk. The distally based peroneus brevis muscle flap (DPBM), a local flap based on the muscular branches of the fibular artery, could pose a pragmatic solution. The objective of this study was to evaluate and quantify DPBM defect reconstruction in the lower leg, especially in elderly, multimorbid and severely ill patients. The DPBM as a surgical option in defect reconstruction in multimorbid, elderly, severely ill patients (inclusion criteria: at least 3 pre-existing comorbidities, patient age: at least 55 years, ASA status: at least III) was evaluated in a retrospective single-centre study from 01 April 2014 to 31 December 2019. The electronic SAP health records (EHR) were analysed according to 18 criteria, including patient details, extent of multimorbidity, defect characteristics, clinical outcome, and complications. Ten patients with a mean age of 72.6 years, a mean number of 8.5 pre-existing comorbidities and a mean ASA status of 3.1 met the inclusion criteria. The leading causes of defects, each with exposed tendons, bones, joint capsule, or joint, were chronic ulcers (n = 5) and soft tissue defects resulting from fractures (n = 3). In case of DMPB the success rate was 100% (no partial or total loss) with a short operating time (mean: 103 min) and a brief postoperative length of stay (mean: 11 d). In 2 patients (20%), DPBM surgery had to be discontinued intraoperatively and an alternative technique of defect reconstruction had to be adopted. The reasons included impaired muscle perfusion and fatty degeneration of the peroneus brevis muscle. The DPBM flap allows straightforward, fast and safe defect reconstruction in the lower extremity, particularly in elderly, multimorbid and severely ill patients at risk. In patients with inadequate peroneal brevis muscle, however, DMPB surgery should be discontinued intraoperatively and the defect reconstructed using alternative techniques.

Peroneus Brevis Muscle Flap as a Tissue Cover for Defect over Lower Mid Leg and Ankle Defects: A Case Series

Mid leg and ankle area are more vulnerable for post-traumatic full thickness soft tissue loss. Implants used in osteosynthesis in this region are also at risk of exposure as its placement is in subcutaneous plane as well as precarious blood supply in shin region. Various options like local flap to free flap are described for reconstruction of small and medium size defects in this region. Peroneus brevis is also well described in literatures. In this case series which was done over the period of six years that includes 10 patients with post-traumatic as well as post orthopaedics surgical intervention defects in lower mid leg and ankle region. Patients were selected for proximally and distally based peroneus brevis muscle flap according to the location of defects. Data regarding age, sex, aetiological factor, size of defect, type of flap, survival of flap, donor site complications were recorded. Out of 10 patients, eight were males and two were females. Major aetiological factor was two wheeler road traffic accident. Majority of the patient had orthopaedic surgical intervention for fracture fixation prior to or along with flap surgery. Only one patient, in this series had marginal flap necrosis. Rest of flaps survived well without any donor site complications. In authors experience peroneus brevis muscle flap is dependable for medium size defects over lower leg and ankle.

Clinical Evaluation of Peroneous Brevis Muscle Flap as a Reconstructive Tool for Defects Around the Ankle

Background: Soft tissue defects of the distal lower extremityare notoriously difficult wounds to treat. This is dueto the paucity of soft tissue in this area and the thin integumentas well as the relatively superficial tendons. Those defectsoften require local rotation flaps, the reverse flow flap or freetissue transfer. The success of local tissue rotation flaps canbe improved with supercharging techniques; however, just aswith free tissue transfers, these techniques require specialsurgical skills. One excellent alternative within the reconstructivespectrum of the lower leg is the distally based peroneusbrevis muscle flap. This muscle flap is a viable option inproperly selected patients for coverage of wounds about theankle.Patients and Methods: In this study, we used the distallybased peroneous brevis muscle flap to reconstruct 20 casesof defects around the ankle. Cases presented to Plastic SurgeryDepartment, Minia University Hospital in period betweenJanuary to October 2017. Surgical procedure was performedunder spinal anaesthesia in all cases. We followed cases for6 months postoperatively.Results: The mean age was 35 years old, 16 patientswere males and 4 were female. 55% of patients had completeflap viability, 15% of cases had partial graft loss and 20%with partial flap necrosis and 10% of cases had completeflap loss.Conclusion: We can suggest that the peroneus brevismuscle flap is an additional valuable option for reconstructionof defects around the ankle because of its adjacent location,reliability, and the relative simplicity of technique. The surgicaltechnique is relatively easy, safe, and suitable for reconstructionof soft-tissue defects in a single stage.

Distally Based Peroneus Brevis Rotation Flap.

Soft tissue defects of the distal leg, ankle, and hindfoot pose challenges for orthopaedic surgeons. The distally based peroneus brevis muscle flap is a viable local muscle rotation flap to cover defects in these challenging circumstances, and can be learned and performed by most orthopaedic surgeons without the need for microvascular techniques. This video demonstrates the technique for a peroneus brevis rotation flap in a patient with a lateral ankle defect and exposed bone.

Local flaps as alast attempt to avoid lower extremity amputation: an overview

HintergrundDie Weichgewebsrekonstruktion bei alten Patienten stellt eine Herausforderung dar. Der freie Gewebetransfer kann bei gesunden Patienten trotz hohen Alters mit hoher Erfolgsrate durchgeführt werden. Bei multimorbiden Patienten, die für den freien Gewebetransfer nicht in Betracht kommen, werden häufig lokale Lappenplastiken eingesetzt, welche mit einer hohen Komplikationsrate assoziiert sind. Gerade solche Rettungseingriffe müssen so gewählt werden, dass eine Amputation durch die Wahl der Entnahmestelle nicht nachteilig beeinflusst wird oder gar unmöglich wird.MethodeDrei distal basierte lokale Lappenplastiken wie Suralis‑, Peronaeus-brevis- und Propellerlappenplastik werden im Hinblick auf die Platzierung der Entnahmestelle sowie die Komplikationen der Wundheilungsstörung diskutiert.ErgebnisseDie Entnahmestelle der Suralislappenplastik ist nachteilig, da die proximale, dorsale Wadenregion betroffen ist, die im Falle einer Unterschenkelamputation die Weichteildeckung des Stumpfes ermöglicht.SchlussfolgerungSoll eine lokale Lappenplastik als „Rettungseingriff“ als Versuch der Vermeidung einer Unterschenkelamputation bei für einen freien Gewebetransfer nichtgeeigneten Patienten zum Einsatz kommen, gilt es, Lappenplastiken zu wählen, die die Entnahmestelle außerhalb der dorsalen, proximalen Wade platzieren, um die Weichteildeckung einer Stumpfbildung potenziell zu ermöglichen.

Peroneus brevis muscle flap for reconstruction of defects around the ankle: Clinical evaluation

Peroneus brevis muscle flap for reconstruction of defects around the ankle: Clinical evaluation

The Reliability of the Distally Based Peroneus Brevis Muscle Flap for Coverage of the Skin Defects Over the Tendo-Achilis

Soft tissue and bone defects of the lower leg, around the ankle, and more distal regions always require coverage by large local or distant flaps. Authors used the distally based peroneus brevis muscle flap for the treatment of 10 patients with soft tissue defects over the tendo-achilis: That occurred after extensive dissection of skin jeopardizing its vascularity or after tendo-ahilis grafting by fascia-lata to reconstruct tendo-achilis. All defects were small to medium sized between 10.56 to 21.84cm2. All flaps passed without major complications. The distally based peroneus brevis muscle represents a very reliable flap for coverage of small and medium defects over the tendo-achilis and may be preferable to the use of free flaps.

Distally based peroneus brevis muscle flap: A single centre experience

PurposeDefects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. MethodsThis is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. ResultsThere were 21 males and 4 females with the mean age of 39 (5–76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4–50) cm2. The mean operating time was 75 (60–90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. ConclusionThe distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.

Repairment of lateral malleol defects with distal pedicled peroneus brevis muscle flap

The availability of local tissue in distal 1/3 of the leg and around the ankle is limited, and the difficulty in re-establishing soft-tissue coverage for these defects continues to challenge surgical procedures. In this study, two cases who had the soft-tissue defects around the lateral malleol reconstructed with the distally pedicled peroneus brevis muscle flap were discussed. The first case was a 30-year-old male patient, who had 4 cm × 2 cm soft-tissue defect with bony exposure, inferior to the lateral malleol after a gunshot injury. The second case was a 26-year-old male patient who had 5 cm × 3 cm soft-tissue defect with exposed metal implant, distal to the lateral malleolus after a traffic accident. Both of the patients were quite satisfied with the esthetic results. The distal pedicled peroneus brevis muscle flap should be kept in mind as a reliable and relatively easy flap option for the reconstruction of the soft-tissue defects around the lateral malleol with good results.

Distally Based Peroneus Brevis Muscle Flap for Large Leg, Ankle, and Foot Defects: Anatomical Finding and Clinical Application.

Peroneus brevis muscle flap is a distinguished, distally based safe flap that can be manipulated to cover small defects in the leg and ankle. For large-sized defects, a more distal, larger flap is required either locally or distantly. Forty-two distally based peroneus brevis muscle flaps were elevated in 42 patients (30 males and 12 females) with major lower leg, ankle, and proximal foot defects of 6 to 15 cm in length and 6 to 12 cm in width. Anatomical findings were recorded as number, size, and sources of blood supply, entry sites, the lowermost two arterial supplies, internal distribution of blood supply to the muscle, the relationship between external and internal distribution of the blood vessels, the length of the muscle, the entry site of the main artery, and the splitting of the proximal portion of the peroneus brevis muscle to increase its width to sufficiently cover large defects. The anatomical findings suggested that the muscle can be safely extended to cover a large defect in the leg, ankle, or proximal foot. In addition, the longitudinal splitting of the muscle increases its width by up to three times, making it an excellent long-surviving flap to cover a large defect. A distally based peroneus brevis muscle flap has a rich blood supply and safely reaches the proximal foot, with a secure splitting to cover large defects in the leg, ankle, and proximal foot.

The Distally Based Peroneus Brevis Flap: The 5-Step Technique.

The peroneus brevis flap was first described as proximally based by Mathes et al (Surg Clin North Am. 1974;54:1337-1354) and later by Jackson and Scheker (Injury. 1982;13:324-330). A distally based version of this flap by Mathes and Nahai (Reconstructive Surgery: Principles, Anatomy and Technique. 1997:1437e46) was subsequently described in 1997. The first case series of distally based flaps was published by Eren et al (Plast Reconstr Surg. 2001;107:1443-1448). In our experience, the distally based flap is a useful muscle flap to reconstruct small defects in the lateral distal third of the leg. Initial interest and confidence in the use of this flap in our unit were hindered by lack of direct experience and descriptive detail in the literature. We have now developed a systematic approach to harvest the distally pedicled peroneus brevis muscle flap in 5 reproducible, safe steps. This has allowed the flap to become adopted as a standard technique of limb reconstruction in our unit with no cases of flap loss.