title: Antegrade Peroneal Flap through the Interosseous Membrane for Knee and Distal Femur Coverage.
abstract: BACKGROUND
  Antegrade peroneal flaps can be rotated around the fibula to cover defects in the lower leg and lateral knee. However, these flaps cannot reliably cover the distal femur and anterior and medial knee. In the present article, the authors describe a novel technical modification that involves creating a tunnel through the interosseous membrane, through which the flap can be passed, circumventing the need to rotate around the fibula, allowing it to reach the entire knee and distal femur.
  
  
  METHODS
  An anatomical study was performed in five cadaveric specimens to measure the gain in pedicle reaching distance when the flap is tunneled compared to transferred around the fibula. A clinical study in 12 patients was also performed to measure the gain in pedicle reaching distance and the long-term viability of the tunneled interosseous flap.
  
  
  RESULTS
  In the anatomical study, the mean reaching distance was 7.4 ± 0.9 cm for the flaps rotated around the fibula and 17.0 ± 1.6 for the tunneled interosseous flaps (p < 0.001). In the clinical study, the mean reaching distance was 2.6 ± 1.4 cm for the flaps rotated around the fibula and 11.4 ± 2.4 for the tunneled interosseous flaps (p < 0.0000000001). Patients were followed for up to 4 years (mean, 2.5 years). All flaps survived completely, and there were no complications.
  
  
  CONCLUSIONS
  By passing the antegrade peroneal flap through the interosseous membrane, instead of around the fibula, the flap reaching distance can be increased by approximately 8 cm, allowing for effective coverage of distal femur and knee defects.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Claudio
authors.initials: C
authors.lastname: Angrigiani
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Artero
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Escudero
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sereday
authors.affiliation: Buenos Aires, Argentina; Seattle, Wash.; and Ann Arbor, Mich.|From the Division of Plastic Surgery, Hospital Santojanni, University of Buenos Aires School of Medicine; Hospital Regional Oscar Allende Mar del Plata; Plastic Surgery Hospital de Quemados; the Division of Plastic Surgery, University of Washington Medical Center; and the University of Michigan Medical School.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Khouri
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery*; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000601:surgery*; D008297:Male; D008566:Membranes / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps