Peroneal Artery Perforator Flap

Abstract

OBJECTIVE: Defect reconstruction at the distal lower extremity by transposition of a vascularised fasciocutaneous flap.INDICATIONS: Reconstruction of defects at the lateral aspect of the middle and distal third of the lower leg, the lateral ankle and achilles tendon region.CONTRAINDICATIONS: Lesions or occlusion of the peroneal artery, traumatized skin and soft tissues at the donor site of the flap, deep vein thrombosis of the ipsilateral leg.SURGICAL TECHNIQUE: Preoperative localisation of the dominant perforator using Duplex or Doppler ultrasound or CT-angiography. Initially limited skin incision and identification and microsurgical dissection of the dominant perforator up to its origin from the peroneal artery. Completion of skin incision and mobilisation of the flap while the secondary perforans vessels are still preserved. Evaluation of flap perfusion and transfer of the flap into the defect by advancement or 180° rotation as a propeller flap. Closure of the donor site defect by direct suture or skin grafts.POSTOPERATIVE MANAGEMENT: Elevation of the extremity for 5 days. Elastocompressive garments and orthostatic training with increasing intensity. Standardised postoperative compression therapy and scar therapy if necessary.RESULTS: Minimal functional donor site defect and optimal functional and aesthetic results.