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Horch et al. Plast Aesthet Res 2018;5:26 Plastic and
DOI: 10.20517/2347-9264.2018.25 Aesthetic Research

Original Article Open Access

When free flaps are not the first choice: is the
distally based peroneus brevis still an option

for foot and ankle reconstruction in the era of
microsurgery?

Raymund E. Horch , Ingo Ludolph , Marweh Schmitz , Anja M. Boos , Ulrich Kneser , Justus P. Beier ,
1
1
1
1
1,3
1,2
Andreas Arkudas 1
1 Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg FAU, Erlangen
D-91054, Germany.
2 Department of Hand, Plastic and Reconstructive Surgery-Burn Center-BG Trauma Center Ludwigshafen, Department of Plastic Surgery,
University of Heidelberg, Ludwigshafen D-67071, Germany.
3 Department of Plastic Hand and Burn Surgery, University Hospital RWTH, Aachen D-52074, Germany.
Correspondence to: Prof. Raymund E. Horch, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-
Alexander University Erlangen-Nuernberg FAU, Erlangen D-91054, Germany. E-mail: raymund.horch@uk-erlangen.de
How to cite this article: Horch RE, Ludolph I, Schmitz M, Boos AM, Kneser U, Beier JP, Arkudas A. When free flaps are not the first
choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery? Plast Aesthet
Res 2018;5:26. http://dx.doi.org/10.20517/2347-9264.2018.25

Received: 16 Apr 2018 First Decision: 23 Jul 2018 Revised: 24 Jul 2018 Accepted: 24 Jul 2018 Published: 31 Jul 2018

Science Editor: Raymund Engelbert Horch Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract

Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without
bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add healthy tissue
especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical
centres. Nevertheless, in some instances pedicled flaps may have indications when free flaps are not suitable.

Methods: The distally based peroneus brevis flap is harvested from the lateral compartment of the leg based on the
distal perforating arterial supply and covered with split skin.

Results: We performed a total of 69 peroneus flaps between 2003 and 2017. Minor flap necroses at the distal tip were
noted in 8% of the peroneus brevis reconstructions. Total flap loss occurred in 1 peroneus flap. Defect etiology and
patient age were not associated with surgical outcome.

Conclusion: While nowadays the first choice of lower extremity reconstruction is an appropriate free flap solution,

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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