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J Reconstr Microsurg 2018; 34(08): 616-623
DOI: 10.1055/s-0038-1661366
Original Article: WSRM 2017 Scientific Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Magdy Ahmed Abd-Al-Moktader
1   Department of Plastic Surgery, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt
› Author Affiliations
Further Information

Publication History

25 December 2017

28 April 2018

Publication Date:
28 June 2018 (online)

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Abstract

Background 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.

Methods 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.

Results 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.

Conclusion 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.

Keywords

distally based peroneus brevis muscle flap - muscle flap in leg, ankle and foot defects - leg, ankle and foot coverage

Ethical Standards

The procedures performed in this study were in accordance with the ethical standards of the Institutional Research Committee (Al-Azhar Faculty of Medicine Ethical Committee, Cairo, Egypt) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Patient Consent

Informed consent from all individual participants included in this study was obtained.


 

  • References

  • 1 Eyssel M, Dresing K. The peroneus brevis muscle flap-plasty. A simple procedure for covering fibular soft tissue defects after osteosynthesis [in German]. Unfallchirurg 1989; 92 (02) 85-91
    PubMedGoogle Scholar
  • 2 Koski EA, Kuokkanen HO, Tukiainen EJ. Distally-based peroneus brevis muscle flap: a successful way of reconstructing lateral soft tissue defects of the ankle. Scand J Plast Reconstr Surg Hand Surg 2005; 39 (05) 299-301
    CrossrefPubMedGoogle Scholar
  • 3 Pers M, Medgyesi S. Pedicle muscle flaps and their applications in the surgery of repair. Br J Plast Surg 1973; 26 (04) 313-321
    CrossrefPubMedGoogle Scholar
  • 4 Pers M, Medgyesi S, Kirkby B. Peroneus brevis muscle flap. In: Strauch B, Vasconez LO, Hall-Findlay EJ, Lee BT. , eds. Grabb's Encyclopedia of Flaps. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: 1408-1409
    Google Scholar
  • 5 Barr ST, Rowley JM, O'Neill PJ, Barillo DJ, Paulsen SM. How reliable is the distally based peroneus brevis muscle flap?. Plast Reconstr Surg 2002; 110 (01) 360-362
    CrossrefPubMedGoogle Scholar
  • 6 Saydam M, Yilmaz S, Seven E. Distal peroneus brevis muscle flap. Plast Reconstr Surg 2002; 110 (01) 351-356 , author reply 351
    PubMedGoogle Scholar
  • 7 Hughes LA, Mahoney JL. Anatomic basis of local muscle flaps in the distal third of the leg. Plast Reconstr Surg 1993; 92 (06) 1144-1154
    CrossrefPubMedGoogle Scholar
  • 8 Lyle WG, Colborn GL. The peroneus brevis muscle flap for lower leg defects. Ann Plast Surg 2000; 44 (02) 158-162
    CrossrefPubMedGoogle Scholar
  • 9 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (02) 177-187
    CrossrefPubMedGoogle Scholar
  • 10 Vasconez LO, Bostwick III J, McCraw J. Coverage of exposed bone by muscle transposition and skin grafting. Plast Reconstr Surg 1974; 53 (05) 526-530
    CrossrefPubMedGoogle Scholar
  • 11 Eren S, Ghofrani A, Reifenrath M. The distally pedicled peroneus brevis muscle flap: a new flap for the lower leg. Plast Reconstr Surg 2001; 107 (06) 1443-1448
    CrossrefPubMedGoogle Scholar
  • 12 McHenry TP, Early JS, Schacherer TG. Peroneus brevis rotation flap: anatomic considerations and clinical experience. J Trauma 2001; 50 (05) 922-926
    CrossrefPubMedGoogle Scholar
  • 13 Villarreal PM, Monje F, Gañán Y, Junquera LM, Morillo AJ. Vascularization of the peroneal muscles. Critical evaluation in fibular free flap harvesting. Int J Oral Maxillofac Surg 2004; 33 (08) 792-797
    CrossrefPubMedGoogle Scholar
  • 14 Draves DJ. Anatomy of the Lower Extremity. 1st ed. Baltimore, MD: Williams & Wilkins; 1986: 258-259
    Google Scholar
  • 15 Gray H. Gray's Anatomy. 15th ed. (1709). New York, NY: Barnes & Noble Books; 1995: 416-417
    Google Scholar
  • 16 Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot: Clinical Biomechanics. 1st ed. Los Angeles, CA: Clinical Biomechanics Corp; 1977: 219-221
    Google Scholar
  • 17 Abd-Al Moktader MA. Open-book splitting of a distally based peroneus brevis muscle flap to cover large leg and ankle defects. Plast Reconstr Surg Glob Open 2016; 3 (12) e572
    PubMedGoogle Scholar
  • 18 Ng YH, Chong KW, Tan GM, Rao M. Distally pedicled peroneus brevis muscle flap: a versatile lower leg and foot flap. Singapore Med J 2010; 51 (04) 339-342
    PubMedGoogle Scholar
  • 19 Yang YL, Lin TM, Lee SS, Chang KP, Lai CS. The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications. J Foot Ankle Surg 2005; 44 (04) 259-264
    CrossrefPubMedGoogle Scholar
  • 20 Taylor GI, Pan WR. Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 1998; 102 (03) 599-616 , discussion 617–618
    CrossrefPubMedGoogle Scholar
  • 21 Mathes SJ, Nahai F. Peroneus brevis flap. In: Mathes SJ, Nahai F. , eds. Reconstructive Surgery: Principles, Anatomy and Techniques. New York, NY: Churchill Livingstone; 1997: 1437-1445
    Google Scholar
  • 22 Bajantri B, Bharathi R, Ramkumar S, Latheef L, Dhane S, Sabapathy SR. Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects. Indian J Plast Surg 2013; 46 (01) 48-54
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Chambers GL, Arsen AN. Characterization of the peroneus brevis muscle for closure of lower extremity defects. A cadaver study and case report. Podiatry Institute. Available at: www.podiatryinstitute.com/pdfs/Update_2002/2002_41.pdf . Accessed December 14, 2017
    PubMedGoogle Scholar
  • 24 Lorenzetti F, Lazzeri D, Bonini L. , et al. Distally based peroneus brevis muscle flap in reconstructive surgery of the lower leg: postoperative ankle function and stability evaluation. J Plast Reconstr Aesthet Surg 2010; 63 (09) 1523-1533
    CrossrefPubMedGoogle Scholar
  • 25 Schmidt AB, Giessler GA. The muscular and the new osteomuscular composite peroneus brevis flap: experiences from 109 cases. Plast Reconstr Surg 2010; 126 (03) 924-932
    CrossrefPubMedGoogle Scholar
  • 26 Kneser U, Brockmann S, Leffler M. , et al. Comparison between distally based peroneus brevis and sural flaps for reconstruction of foot, ankle and distal lower leg: an analysis of donor-site morbidity and clinical outcome. J Plast Reconstr Aesthet Surg 2011; 64 (05) 656-662
    CrossrefPubMedGoogle Scholar
  • 27 El-Khatib HA. The split peroneus muscle flap: a new flap for lower leg defects. J Plast Reconstr Aesthet Surg 2007; 60 (08) 898-903
    CrossrefPubMedGoogle Scholar
  • 28 Bach AD, Leffler M, Kneser U, Kopp J, Horch RE. The versatility of the distally based peroneus brevis muscle flap in reconstructive surgery of the foot and lower leg. Ann Plast Surg 2007; 58 (04) 397-404
    CrossrefPubMedGoogle Scholar