Free Peroneal Artery Perforator-Based Flap for Soft Tissue Reconstruction of the Finger

Abstract

Background The peroneal artery perforator-based flap has been widely used as a pedicled propeller flap for soft tissue reconstruction in the lower extremity; however, its application as a free flap has been rarely reported. We report on the utility of the free peroneal artery perforator-based flap for finger soft tissue reconstruction.

Methods Twelve patients underwent reconstructions of soft tissue defects of the finger with free peroneal artery perforator-based flaps. The soft tissue defects were located either dorsally and/or laterally on the fingers. The size of the flaps ranged from 5 × 2 to 8 × 3 cm. The length of the vascular pedicles ranged from 4 to 5 cm. The artery and vein of the perforator vessels were anastomosed in the finger to the digital artery and subcutaneous vein, respectively.

Results All twelve flaps survived completely, and the donor site in the lower leg was closed primarily in all cases. Secondary defatting was performed in six cases, while in the remaining cases, thinning of the flap was performed when the flap was transferred.

Conclusion The advantages of the free peroneal artery perforator-based flap for finger soft tissue reconstruction include the following: the flap is flexible and can be thinned to match the texture of the finger; elevation of the flap is easy; the donor site can be closed primarily; there is no need to sacrifice any main arteries in the lower leg; and the diameter of the perforator vessels is suitable for anastomosis to the digital artery and subcutaneous vein in the finger.

Keywords

perforator flap - peroneal artery perforator-based flap - finger reconstruction

• References

• 1 Yoshimura M, Imura S, Shimamura K, Yamauchi S, Nomura S. Peroneal flap for reconstruction in the extremity: preliminary report. Plast Reconstr Surg 1984; 74 (03) 402-409
• 2 Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: an alternative to classic donor areas in comorbid patients. Microsurgery 2015; 35 (05) 399-402
• 3 Baj A, Beltramini GA, Demarchi M, Giannì AB. Extended-pedicle peroneal artery perforator flap in intraoral reconstruction. Acta Otorhinolaryngol Ital 2013; 33 (04) 282-285
• 4 Wolff KD, Bauer F, Wylie J, Stimmer H, Hölzle F, Kesting M. Peroneal perforator flap for intraoral reconstruction. Br J Oral Maxillofac Surg 2012; 50 (01) 25-29
• 5 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
• 6 Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A. The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 1992; 90 (04) 643-649
• 7 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 1995; 96 (07) 1608-1614
• 8 Shen L, Liu Y, Zhang C. , et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res 2017; 45 (03) 1074-1089
• 9 Ahn DK, Lew DH, Roh TS, Lee WJ. Reconstruction of ankle and heel defects with peroneal artery perforator-based pedicled flaps. Arch Plast Surg 2015; 42 (05) 619-625
• 10 Kawamura K, Yajima H, Kobata Y, Shigematsu K, Takakura Y. Clinical applications of free soleus and peroneal perforator flaps. Plast Reconstr Surg 2005; 115 (01) 114-119
• 11 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (01) 53-54
• 12 Yabe T, Takahashi M, Kamano M. The free true perforator flap. J Reconstr Microsurg 2007; 23 (06) 329-333
• 13 Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer. Plast Reconstr Surg 1990; 85 (06) 917-921
• 14 Yajima H, Ishida H, Tamai S. Proximal lateral leg flap transfer utilizing major nutrient vessels to the soleus muscle. Plast Reconstr Surg 1994; 93 (07) 1442-1448
• 15 Hupkens P, Schijns W, Van Abeelen M, Kooloos JG, Slater NJ, Ulrich DJ. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators. Microsurgery 2015; 35 (02) 140-147