title: [Muscular and osteomuscular peroneus brevis flaps].
abstract: OBJECTIVE
  Soft tissue defect reconstruction by transposition of well-vascularized muscle tissue with a muscle flap and as an osteomuscular flap together with a fibular bone segment for combined skeletal and soft tissue defects.
  
  
  METHODS
  Small- and medium-sized defects of the hindfoot, around the ankle and the distal and middle third of the lower leg, skeletal reconstruction of underlying small- and medium-sized bone defects.
  
  
  METHODS
  Lesions of the proximal anterior tibial artery (proximal pedicled flap), combined lesions of the distal peroneal artery including the communicating branch with the posterior tibial artery (distal pedicled flap); lesion or paralysis of the peroneus longus muscle in an intact ankle joint.
  
  
  METHODS
  Distally pedicled flap: blunt separation between the peroneus longus and brevis muscle, subperiosteal release with isolation on a distal septocutaneous branch of the peroneal artery. To increase perfusion, the proximally released branch of the anterior tibial artery may be re-anastomosed in the recipient site. Proximally pedicled flap: dissection of distal peroneus brevis muscle tendon and subperiosteal release in a proximal direction with ligation of the segmental peroneal artery branches until the flap is isolated on its proximal anterior tibial artery branch. For an osteomuscular flap, simultaneous harvest of a fibula segment underneath the muscle origin with preservation of the intimate periosteal relationship between muscle and bone.
  
  
  METHODS
  Complete immobilization and elevated leg position for 5 days, followed by successive orthostatic training for 10 days. Postoperative standardized compression garments for 6 months, eventually combined with silicone sheet scar therapy.
  
  
  RESULTS
  Reliable, excellent functional and aesthetic results with very low donor site morbidity.
authors.affiliation: Klinik für Plastisch-rekonstruktive, Ästhetische und Handchirurgie, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland. giesslerplasticsurgery@hotmail.com
authors.forename: G A
authors.initials: GA
authors.lastname: Giessler
authors.forename: A B
authors.initials: AB
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult