CC BY-NC 4.0 · Arch Plast Surg 2017; 44(02): 136-143
DOI: 10.5999/aps.2017.44.2.136
Original Article

Peroneal Flap: Clinical Application and Cadaveric Study

Yooseok Ha
Department of Plastic and Reconstructive Surgery, Chungnam National University, Daejeon, Korea
,
Kwan Koo Yeo
Jinan Public Health Care Center, Jinan, Korea
,
Yibo Piao
Department of Plastic and Reconstructive Surgery, Chungnam National University, Daejeon, Korea
Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
,
Sang-Ha Oh
Department of Plastic and Reconstructive Surgery, Chungnam National University, Daejeon, Korea
Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
› Author Affiliations
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2013R1A1A1057928).

Background The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps.

Methods The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients.

Results We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from 2.0 cm×4.5 cm to 8.0 cm×8.0 cm. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures.

Conclusions The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap.

This work was also supported by the research fund of Chungnam National University.




Publication History

Received: 03 September 2016

Accepted: 04 January 2017

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 Morris SF, Tang M, Almutari K. et al. The anatomic basis of perforator flaps. Clin Plast Surg 2010; 37: 553-570
  • 2 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55: 533-544
  • 3 Yoshimura M, Imura S, Shimamura K. et al. Peroneal flap for reconstruction in the extremity: preliminary report. Plast Reconstr Surg 1984; 74: 402-409
  • 4 Yoshimura M, Shimada T, Imura S. et al. Peroneal island flap for skin defects in the lower extremity. J Bone Joint Surg Am 1985; 67: 935-941
  • 5 Chen YL, Zheng BG, Zhu JM. et al. Microsurgical anatomy of the lateral skin flap of the leg. Ann Plast Surg 1985; 15: 313-318
  • 6 Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 2008; 122: 161-170
  • 7 Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer. Plast Reconstr Surg 1990; 85: 917-921
  • 8 Heitmann C, Khan FN, Levin LS. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 2003; 19: 157-162
  • 9 Beppu M, Hanel DP, Johnston GH. et al. The osteocutaneous fibula flap: an anatomic study. J Reconstr Microsurg 1992; 8: 215-223
  • 10 Yajima H, Ishida H, Tamai S. Proximal lateral leg flap transfer utilizing major nutrient vessels to the soleus muscle. Plast Reconstr Surg 1994; 93: 1442-1448
  • 11 Papadimas D, Paraskeuopoulos T, Anagnostopoulou S. Cutaneous perforators of the peroneal artery: cadaveric study with implications in the design of the osteocutaneous free fibular flap. Clin Anat 2009; 22: 826-833
  • 12 Lee JS, Patel KM, Zou Z. et al. Computerized tomographic and magnetic resonance angiography for perforator-based free flaps: technical considerations. Clin Plast Surg 2011; 38: 219-228
  • 13 Alonso-Burgos A, Garcia-Tutor E, Bastarrika G. et al. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience. J Plast Reconstr Aesthet Surg 2006; 59: 585-593