Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy.
J Plast Reconstr Aesthet Surg. 2010 Sep;63(9):1523-33. doi: 10.1016/j.bjps.2009.08.003. Epub 2009 Sep 30.
Defects of the distal third of the lower leg with exposed tendons or bone require either local or free flap coverage. Several flaps have been developed, and the distally pedicled peroneus brevis muscle flap has been proven to be a valid local flap alternative.
Peroneus brevis muscle is dissected from the lateral surface of the fibula from proximal to distal, but no further than approximately 3-6 cm proximally to the lateral malleolus, where the most distal vascular pedicle from the peroneal artery enters the muscle consistently. This allows the muscle to be transposed to more distal lesions. The muscle is then covered with meshed split-skin graft. Between 2002 and 2008, 10 patients with defects of the lower leg in the distal lower third have been treated using this muscle flap. The defects were located over the Achilles tendon, the medial and lateral malleolar, the anterior region of the ankle and the heel area. Each patient was examined through assigning clinical demerit points according to a modified Weber scale, and through Olerud-Molander ankle score to analyse postoperative ankle stability and functionality after reverse peroneus brevis flap reconstruction of the defect.
All flaps survived completely, and no secondary local flap was required. In our experience, no complication or patient discomfort was noted. Donor-site morbidity was acceptable and restricted to the scar in the lateral lower leg. As demonstrated by the two score evaluations, the functions of foot eversion and plantar flexion as well as ankle functionality and stability were maintained due to preservation of peroneus longus muscle.
The reverse peroneus muscle flap is ideally suited for small-to-moderate defects of the distal third of the lower leg. This flap offers a convincing alternative for covering defects in the distal leg region. Its arc of rotation allows coverage of more anterior defects of the ankle, of defects of the Achilles tendon and of the heel area as well as of lateral and medial malleolus areas. It is simple to raise and is often transposed easily within the wound without further dissection. As long as the peroneus longus is preserved, ankle instability is not expected.
小腿下段三分之一处有外露肌腱或骨骼的缺损需要局部或游离皮瓣覆盖。已经开发了几种皮瓣，而带蒂的腓骨短肌皮瓣已被证明是一种有效的局部皮瓣替代物。
从腓骨的外侧表面从近端到远端解剖腓骨短肌，但不要超过外踝近端约 3-6 厘米，因为来自腓动脉的最远端血管蒂始终进入肌肉。这允许肌肉向更远端的病变移位。然后用网状游离皮片覆盖肌肉。在 2002 年至 2008 年间，使用这种肌皮瓣治疗了 10 例小腿下段三分之一处有缺损的患者。缺损位于跟腱、内外踝、踝关节前区和足跟区。根据改良 Weber 量表为每位患者分配临床扣分，并通过 Olerud-Molander 踝关节评分分析反向腓骨短肌皮瓣重建缺损后的踝关节稳定性和功能。
所有皮瓣均完全存活，无需进行二次局部皮瓣。根据我们的经验，没有注意到并发症或患者不适。供区发病率可接受，仅限于小腿外侧的疤痕。正如两项评分评估所示，由于保留了腓骨长肌，足外翻和跖屈功能以及踝关节功能和稳定性得以维持。
反向腓骨肌皮瓣非常适合小腿下段三分之一处的小到中等大小的缺损。这种皮瓣为覆盖小腿下段的缺损提供了一个令人信服的替代方案。它的旋转弧允许覆盖更靠前的踝关节缺损、跟腱缺损和足跟区缺损以及内外踝区缺损。它易于提起，并且通常可以在不进一步解剖的情况下轻松地在伤口内转移。只要保留腓骨长肌，就不会出现踝关节不稳定。
