title: Reconstruction of distal hand and foot defects with the free proximal peroneal artery perforator flap.
abstract: BACKGROUND
  The proximal peroneal artery perforator (PPAP) flap is a reliable, thin fasciocutaneous flap. The purpose of this article was to report our experience with the use of free PPAP flaps for reconstruction of defects of the distal hand and foot.
  
  
  METHODS
  From November 2012 to September 2013, 9 patients received reconstruction with 10 free PPAP flaps. The defect locations included the big toe (2 cases), metatarsophalangeal joint (5 cases), dorsal finger (2 cases) and volar finger (1 case). Flaps were raised based on proximal peroneal perforator vessels without sacrificing the peroneal artery. The first dorsal metatarsal artery (5 cases) and digital artery (5 cases) were dissected as recipient vessels.
  
  
  RESULTS
  The flap sizes varied from 2.5 x 2 cm to 9 x 5 cm. All of flaps were survival after surgery. One flap suffered from venous thrombosis and was successfully salvaged by performing a venous thrombectomy and vein graft. The donor sites were all primarily closed with minimal morbidities. Follow-up observations were conducted for 7 to 20 months, and all patients had good functional recovery with satisfying cosmetic results.
  
  
  CONCLUSIONS
  Perforators arising from the peroneal artery in the proximal lateral leg can be used to design small, pliable fasciocutaneous flaps. Although the pedicle is short, the vessel diameter is adequate for microvascular anastomosis to the distal foot and hand recipient vessels. The free PPAP flap may be a good option for reconstructing distal hand and foot defects.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Scaglioni
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yur-Ren
authors.initials: YR
authors.lastname: Kuo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yen-Chou
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply / Q000601:surgery; D018409:Foot Injuries / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006225:Hand / Q000098:blood supply / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: distal hand and foot defects; free flap; proximal peroneal artery perforator flap