Page 193 - Read Online

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,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net