REVERSE PERONEAL FLAPS - 2 SURGICAL APPROACHES

The peroneal vascular pedicle supplies the posterolateral aspect of th e lower limb and can be used in a reverse-flow manner to reliably cove r wounds of the lower third of the leg and ankle. Two surgical approac hes may be used, medial and lateral, to treat a variety of soft-tissue deficits. For the medial approach, the patient is positioned supine a nd the flexor hallucis longus muscle along with the peroneal vascular pedicle is raised. This easily covers medial malleolar or distal anter ior tibial defects. For the lateral approach, the patient is positione d prone and a fasciocutaneous flap is dissected and can be used to cov er soft-tissue defects down to the proximal foot and ankle. A total of 13 patients underwent reverse peroneal flaps with a follow-up of 6 mo nths to 3 years. All patients healed their wounds, but there were mino r wound complications in 4 patients. When used in a reverse-flow manne r, the peroneal vascular system can allow for a wide variety of flap d esigns to treat selected patients.