title: Modified reversed superficial peroneal artery flap in the reconstruction of ankle and foot defects following severe burns or trauma.
abstract: OBJECTIVE
  Challenges persist in the reconstruction of the ankle and the foot with exposed tendons, joints, and bones as a result of severe burns and trauma. In flap elevation involving the sensitive superficial nerve, the local nerve was always sacrificed to obtain an anesthetic donor site; however, such a procedure introduced the possibility of painful neuromas. In this study, we present a desired clinical application of a modified reversed superficial peroneal artery flap, in which the superficial peroneal nerve is preserved.
  
  
  METHODS
  From 2008 to 2015, 12 patients with ankle or foot defects were treated with the modified reversed superficial peroneal artery flap. The defects of the patients were caused by hot liquid scald (one patient), electrical injury (five patients), and trauma (six patients). The flap was utilized for covering defects on the ankle (seven patients) and the foot (five patients). The size of the flaps ranged from 4.0cm×6.0cm to 18.0cm×10.0cm. The superficial peroneal artery was involved in the flap, whereas the superficial peroneal nerve was spared by dedicate dissection. The reverse-flow flap was nourished by the superficial peroneal artery through the terminal peroneal artery perforator.
  
  
  RESULTS
  The obtained outcomes were satisfactory functionally and aesthetically. The flaps in 11 patients survived completely without complications, whereas partial necrosis occurred in a 78-year-old patient when the flap survived a week later during follow up. CT angiography revealed the stenosis of the popliteal artery. The wound healed after interventional treatment involving placing a stent and changing the dressings. Basic functions and configurations were salvaged in all cases. All patients were completely satisfied with the proposed flap and suffered no paresthesia in their lower leg.
  
  
  CONCLUSIONS
  Exhibiting beneficial characteristics such as reliable blood supply, favorable thickness, wide rotating arc, and retention of major vessels and the superficial peroneal nerve, the modified reversed superficial peroneal artery flap is useful in the reconstruction of ankle and foot defects that would not cause any hypoesthesia of the foot.
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Shi-Ji
authors.initials: SJ
authors.lastname: Li
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Jian-Yang
authors.initials: JY
authors.lastname: Xu
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China. Electronic address: xulinchen@126.com.
authors.forename: Xu-Lin
authors.initials: XL
authors.lastname: Chen
authors.affiliation: School of Pharmacy, Anhui Medical University, Mei Shan Road, Hefei, Anhui 230032, China; Institute for Liver Disease of Anhui Medical University, Mei Shan Road, Hefei, Anhui 230032, China. Electronic address: lxw31288@aliyun.com.
authors.forename: Xiong-Wen
authors.initials: XW
authors.lastname: Lv
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D001158:Arteries; D002056:Burns / Q000601:surgery*; D002648:Child; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult
keywords: Ankle and foot reconstruction; Burns; Superficial peroneal flap; Trauma