title: The proximally based peroneal vascular bundle: an insulated extension cord for free flap reconstruction.
abstract: Large, traumatic wounds around the proximal third of the lower extremity may have disrupted local vasculature, potentially obviating local pedicled options. However, free-tissue transfer to this area is technically challenging given the resulting paucity of recipient options and the depth of principal blood vessels. We present an anatomic and radiographic study of the proximally based peroneal vascular bundle as a recipient option in the proximal leg. Optimal approach was prone, through an incision over the fibula with dissection between lateral and posterior compartments. Magnetic resonance angiography demonstrated consistent vascular anatomy between patients. A proximally based peroneal vascular bundle protected by a cuff of flexor hallucis longus was used as a recipient vessel in free flap reconstruction of an open knee wound. The bundle itself does not require coverage by virtue of its own local muscle cuff. Caveats for its use include the need for adequate leg inflow and foot outflow.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Sailon
authors.forename: Derek D
authors.initials: DD
authors.lastname: Reformat
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hecht
authors.forename: Evan S
authors.initials: ES
authors.lastname: Garfein
authors.forename: Jason A
authors.initials: JA
authors.lastname: Spector
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.forename: Pierre B
authors.initials: PB
authors.lastname: Saadeh
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D004210:Dissection / Q000379:methods; D006801:Humans; D007717:Knee / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*