title: Descending branch of the perforating branch of the peroneal artery perforator-based island flap for reconstruction of the lateral malleolus with minimal invasion.
abstract: BACKGROUND
  Reconstruction of intractable ulcers on the lateral malleolus is challenging because affected patients suffer various complications. A lateral supramalleolar flap, nourished by the superficial cutaneous branch of the perforating branch of the peroneal artery, has been described as one of the most reliable methods for reconstructing this difficult region. Although the deep descending branch of the perforating branch of the peroneal artery has a tiny cutaneous perforator, a flap based on this perforator has not been described.
  
  
  METHODS
  The vascular anatomy of an island flap based on the descending branch perforator of the perforating branch of the peroneal artery was investigated using 20 cadaver legs. Distances from the lateral malleolus and the external diameters were investigated. Based on the anatomical study results, a perforator-based island flap was developed for clinical use and implemented in five cases.
  
  
  RESULTS
  The anatomical study revealed the descending branch perforator diameter to be smaller than the superficial cutaneous branch diameter, and the location to be considerably closer to the lateral malleolus. All five island flaps used clinically survived without complications.
  
  
  CONCLUSIONS
  A new perforator-based island flap of the descending branch of the perforating branch of the peroneal artery for reconstruction of the lateral malleolus was designed. The territory covered by the flap could be enlarged by including the adjacent angiosome area of the superficial cutaneous branch. This flap elevation technique was uncomplicated and sufficiently straightforward to be used for patients at high risk for complications with extended surgical procedures.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Chiba City, Japan From the Department of Plastic, Reconstructive and Aesthetic Surgery and the Department of Bioenvironmental Medicine, Chiba University, Faculty of Medicine; and the Department of Plastic and Reconstructive Surgery, Chiba Rosai Hospital.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Akita
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mitsukawa
authors.forename: Naoaki
authors.initials: N
authors.lastname: Rikihisa
authors.forename: Juni
authors.initials: J
authors.lastname: Himeta
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubota
authors.forename: Natsuko
authors.initials: N
authors.lastname: Shimada
authors.forename: Hideki
authors.initials: H
authors.lastname: Tokumoto
authors.forename: Takane
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kaneshige
authors.initials: K
authors.lastname: Satoh
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery; D002102:Cadaver; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007866:Leg / Q000033:anatomy & histology / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012494:Sampling Studies; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply*; D013639:Tarsal Bones / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery