Distally based peroneus brevis flap: a reliable and versatile flap to cover the lateral foot and ankle

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

BACKGROUND

Managing 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 METHODS

A 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.

RESULTS

Ten 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.

CONCLUSIONS

The 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.

Lower Limb Muscle Flaps: The Reverse Peroneus Brevis Flap

Chronic ulcerations of the lower extremity centered around the lateral malleolus, medial malleolus, Achilles tendon, or anterior ankle are complex and difficult to heal with conventional treatment modalities. With the evolution of orthoplastics and microsurgery techniques, the peroneus brevis muscle flap has been shown to be simple, versatile, and effective in management of small to medium-sized soft tissue defects that may or may not have exposed bone, tendon, or both. This article reviews the peroneus brevis muscle flap in lower extremity reconstruction and presents pertinent real-world cases of its applications as a tool for limb salvage and orthoplastic reconstruction.

Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical)

Soft tissue defects and wound healing complications related to calcaneus fractures may result in significant morbidity. The management of these soft tissue complications requires following reconstructive principles that provide the requisites for preservation of the injured limb and the maximization of function. Soft tissue complications are addressed with methods that commensurate with the degree of injury, ranging from local wound care to free flap reconstruction. With the orthoplastic approach to both bone and soft tissue plastic reconstruction, outcomes for limb salvage are greatly enhanced. This article discusses in detail the reconstructive ladder for soft tissue injuries associated with calcaneus fractures.

Healing Heel Ulcers in High-Risk Patients: Distally Based Peroneus Brevis Muscle Flap Case Series

The purpose of this study was to demonstrate use of a distally based peroneus brevis muscle flap in high-risk patients with diabetes and peripheral vascular disease for limb salvage of nonhealing heel ulcerations. Seventeen patients were referred for a below-knee amputation because of nonhealing heel ulcerations and peripheral vascular disease. As a last resort, 17 distally based peroneus brevis muscle flaps were elevated in 17 patients with full-thickness heel ulcerations measuring an average defect size of 14.11 cm2. All flaps were supplemented with concentrated bone marrow aspirate, negative pressure wound therapy, bilayer wound matrix, and static external fixation for an average time of 10.3 weeks. Split-thickness skin graft was delayed by an average of 17.5 days. All procedures were performed on patients diagnosed with diabetes, advanced peripheral arterial disease and a nonhealing heel ulcer present >1 year. All flaps survived at 1.5 years follow-up. The average time to healing was 10.3 weeks. No major amputations were performed to date. Partial tip necrosis occurred in 2 patients and healed uneventfully with local wound care. Distally based peroneus brevis muscle flaps in patients with diabetes and peripheral vascular disease offer a reliable alternative to limb salvage for full-thickness heel ulcerations measuring up to 7 × 6 cm. Combinatorial procedures are necessary to improve outcomes in high-risk patients whose alternative is a major amputation.