Malahias Marco, Khalil Haitham, Abdalbary Sahar Ahmed, Abdelkader Rasha
Consultant for Plastic Surgery, University Hospitals Birmingham, Birmingham, UK.
Plastic and Reconstructive Surgeon, Plastic and Reconstructive Surgery Department, University Hospitals Birmingham, Birmingham, U.K.
Plast Reconstr Surg Glob Open. 2020 Dec 18;8(12):e3290. doi: 10.1097/GOX.0000000000003290. eCollection 2020 Dec.
Reconstruction of the distal 3rd of the lower leg requires either local or free flap coverage if tendons or bones are exposed. The distally based, pedicled peroneus brevis (PB) flap has been shown to be a valid option in the management of distal 3rd lower limb injuries. Herein, we present 21 cases treated with distally-based PB muscle flaps between May 2017 and September 2019. The defect location varied, and included defects over the lateral and medial malleolar areas, distal tibia (middle and distal 3rd junction, and the distal 3rd), and Achilles tendon area.
The PB was dissected from the lateral fibula and intermuscular septa in a cephalic to caudal direction, to a point no lower than 7 cm proximal to the lateral malleolus tip. This preserved most distal vascular perforators to the muscle, and afforded sufficient mobilization to allow successful turn-over of the muscle, with transposition into the defect within 30 minutes of tourniquet time. A meshed skin graft completed the intervention.
The metalwork was removed in all chronic cases (10/21), as bone union had occurred. All flaps survived completely. One patient partially lost the skin graft; the wound was healed by secondary intention. No major complications occurred and no significant patient discomfort was noted. All wounds healed completely by 9 weeks of follow-up.
The PB turnover muscle flap is a versatile flap, ideally suited to manage up to moderately sized defects of the distal 3rd of the lower leg, with negligible postoperative morbidity.
如果小腿远端三分之一处的肌腱或骨骼暴露，需要采用局部或游离皮瓣覆盖进行修复。远端带蒂的腓骨短肌（PB）皮瓣已被证明是治疗小腿远端三分之一损伤的有效选择。在此，我们介绍2017年5月至2019年9月期间采用远端带蒂PB肌皮瓣治疗的21例病例。缺损部位各不相同，包括外踝和内踝区域、胫骨远端（中三分之一与远三分之一交界处以及远三分之一处）和跟腱区域的缺损。
从外侧腓骨和肌间隔向头侧至尾侧方向解剖PB，至外踝尖近端不低于7厘米处。这样保留了大部分至肌肉的最远端血管穿支，并提供了足够的活动度，以便在止血带使用时间30分钟内成功翻转肌肉并转移至缺损处。用网状皮片完成干预。
所有慢性病例（10/21）均因骨愈合而取出内固定物。所有皮瓣均完全存活。1例患者皮片部分丢失，伤口通过二期愈合。未发生重大并发症，也未观察到患者有明显不适。随访9周时所有伤口均完全愈合。
PB翻转肌皮瓣是一种多功能皮瓣，非常适合处理小腿远端三分之一处中等大小的缺损，术后发病率可忽略不计。
