title: The muscular and the new osteomuscular composite peroneus brevis flap: experiences from 109 cases.
abstract: BACKGROUND
  Pedicled peroneus brevis muscles are proven flaps for defect coverage around the ankle, foot, and distal lower leg. Some of these defects--such as postosteitic hollowed out calcaneal bones--may profit from a simultaneous vascularized bone transplantation. The authors' experiences with 109 successive muscular and newly developed osteomuscular peroneus flaps are outlined for small to medium combined defects in this region.
  
  
  METHODS
  One hundred nine patients with various soft-tissue and skeletal defects underwent reconstruction with proximally (n = 10) or distally pedicled (n = 98) or free microvascular transplanted (n = 1) peroneus brevis flaps. Eight patients received a composite flap of the peroneus brevis muscle with an attached lateral split fibula segment.
  
  
  RESULTS
  In 72.5 percent of the cases, a stable defect closure was achieved without significant secondary procedures. In 16.5 percent, further operations such as secondary wound closure or flaps were necessary, most often because of the avascular loss of the 1 to 3 cm of the distal flap tip. Nine flaps (8.3 percent) were lost completely. Seven of eight osteomuscular flaps demonstrated stable bony healing, and full weight bearing was achieved. No relevant donor-site complications were seen.
  
  
  CONCLUSIONS
  The peroneus brevis is a valuable flap for defect closure around the ankle and lower leg. It can be harvested together with a vascularized split fibula segment, representing a simple alternative to several free composite flaps. Its complication rate can be lowered significantly if the proximal 3 cm of the muscle origin (i.e., the flap tip in distally pedicled flaps) is discarded during dissection and delicate hemostasis is performed.
authors.affiliation: Murnau am Staffelsee, Germany From the Department of Plastic, Hand, and Reconstructive Microsurgery, BG Trauma Center.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Schmidt
authors.forename: Goetz A
authors.initials: GA
authors.lastname: Giessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D007867:Leg Bones / Q000637:transplantation; D007869:Leg Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps; D055815:Young Adult
references.citation: Pers M, Medgyesi S. Pedicle muscle flaps and their applications in the surgery of repair. Br J Plast Surg. 1973;26:313–321.
references.citation: 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. Vol. 3, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2009:1408–1409.
references.citation: 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;92:85–91.
references.citation: Lyle WG, Colborn GL. The peroneus brevis muscle flap for lower leg defects. Ann Plast Surg. 2000;44:158–162.
references.citation: McHenry TP, Early JS, Schacherer TG. Peroneus brevis rotation flap: Anatomic considerations and clinical experience. J Trauma 2001;50:922–926.
references.citation: Eren S, Ghofrani A, Reifenrath M. The distally pedicled peroneus brevis muscle flap: A new flap for the lower leg. Plast Reconstr Surg. 2001;107:1443–1448.
references.citation: 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;110:360–362.
references.citation: 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;58:397–404.
references.citation: 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;39:299–301.
references.citation: 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;44:259–264.
references.citation: Fansa H, Frerichs O, Schneider W. Distally pedicled peroneus brevis muscle flap for defect coverage on the lower leg (in German). Unfallchirurg 2006;109:453–456.
references.citation: Forni I. Pedicled tendon transfer in the repair of subcutaneous rupture of the Achilles tendon. Ital J Orthop Traumatol. 1981;7:299–303.