Bajantri Babu, Bharathi Ravindra, Ramkumar Sanjai, Latheef Latheesh, Dhane Smitha, Sabapathy S Raja
Departments of Plastic, Hand and Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Indian J Plast Surg. 2013 Jan;46(1):48-54. doi: 10.4103/0970-0358.113706.
Peroneus brevis is a muscle in the leg which is expendable without much functional deficit. The objective of this study was to find out its usefulness in coverage of the defects of the lower leg and ankle.
A retrospective analysis of the use of 39 pedicled peroneus brevis muscle flaps used for coverage of defects of the lower leg and ankle between November 2010 and December 2012 was carried out. The flaps were proximally based for defects of the lower third of the leg in 12 patients and distally based for reconstruction of defects of the ankle in 26 patients, with one patient having flaps on both ankles.
Partial flap loss in critical areas was found in four patients requiring further flap cover and in non-critical areas in two patients, which were managed with a skin graft. Three of the four critical losses occurred when we used it for covering defects over the medial malleolus. There was no complete flap loss in any of the patients.
This flap has a unique vascular pattern and fails to fit into the classification of the vasculature of muscles by Mathes and Nahai. The unusual feature is an axial vessel system running down the deep aspect of the muscle and linking the perforators from the peroneal artery and anterior tibial artery, which allows it to be raised proximally or distally on a single perforator. The flap is simple to raise and safe for the reconstruction of small-to moderate-sized skin defects of the distal third of the tibia and all parts of the ankle except the medial malleolus, which is too far from the pedicle of the distally based flap. The donor site can be closed primarily to provide a linear scar. The muscle flap thins with time to provide a good result aesthetically at the primary defect.
腓骨短肌是小腿的一块肌肉，切除后功能缺陷不大。本研究的目的是探讨其在覆盖小腿和踝关节缺损方面的作用。
对2010年11月至2012年12月间39例采用带蒂腓骨短肌肌皮瓣覆盖小腿和踝关节缺损的病例进行回顾性分析。其中12例小腿下1/3缺损患者采用近端蒂皮瓣，26例踝关节缺损重建患者采用远端蒂皮瓣，1例双侧踝关节均采用皮瓣。
4例关键区域皮瓣部分坏死，需进一步皮瓣覆盖；2例非关键区域皮瓣部分坏死，采用植皮处理。4例关键区域皮瓣坏死中有3例发生在内踝缺损覆盖时。所有患者均未出现皮瓣完全坏死。
该皮瓣具有独特的血管模式，不符合Mathes和Nahai的肌肉血管分类。其独特之处在于有一个轴向血管系统沿肌肉深层走行，连接腓动脉和胫前动脉的穿支，使得皮瓣可基于单一穿支在近端或远端掀起。该皮瓣掀起操作简单，用于重建胫骨远端1/3及除内踝外踝关节各部位的中小面积皮肤缺损安全可靠，内踝距远端蒂皮瓣蒂部较远，不适用于该皮瓣覆盖。供区可直接缝合，形成线状瘢痕。随着时间推移，肌皮瓣会变薄，在原缺损部位可获得良好的美学效果。
