Reverse Peroneal Artery Flap-A Workhorse Flap for Reconstruction of Large, Distal Defects of Ankle and Foot

Abstract

Background Reconstruction of large foot and ankle defects is a difficult task due to less available local soft tissue and more critical from functional point of view. To overcome the limitations associated with locoregional flaps and free flaps, reverse peroneal artery (RPA) flap was selected and its usefulness in reconstruction of distal large defects of the ankle and foot and its complications were studied. Materials and Methods This is a prospective observational study done in 20 patients treated as cohort within 2 years and 8 months from January 2018 to August 2020. Large defects of foot and ankle were reconstructed with RPA flap and evaluated for its usefulness. Three cases were evaluated with computed tomography angiography postoperatively, to assess the vascular pattern. Conclusion RPA flap is a versatile and very reliable flap for the reconstruction of large and distal defects of foot and ankle. It is safely done in children and in acute trauma without any major complications.

Keywords: CT peripheral angiogram; peroneal artery communications; peroneal perforator fasciocutaneous flaps; reconstruction of foot and ankle defects; reverse flow flaps; reverse peroneal artery flap.

Fig. 1

Preoperative planning of reverse peroneal artery flap, P denotes the pivot point of the flap.

Fig. 2

Normal communications of peroneal artery with anterior tibial and posterior tibial arteries. RPA, reverse peroneal artery.

Fig. 3

( A–F ) The various steps of the reverse peroneal artery flap.

Fig. 4

Postoperative findings in computed tomography angiography. Findings of the flap limb versus normal limb. RPA, reverse peroneal artery.

Fig. 5

Dorsum of foot ( A and C ) along with ankle defects ( B ) reconstructed with reverse peroneal artery (RPA) flap. Far-right photos in A and B depict the follow-up pictures of the flap after 6 months of surgery. ( A ) Case 1—A 30-year-old male with posttraumatic defect over dorsum of foot with size 137 cm reconstructed, with RPA flap of size 28 8cm. Flap settled well. ( B ) Case 2—A 30-year-old male patient with posttraumatic defect over the dorsum of foot and ankle of size 157cm was reconstructed with RPA flap of size 229 cm. Flap settled well. ( C ) Case 3—A 25-year-old male patient with posttraumatic defect over dorsum of left foot of size 116 cm was reconstructed with RPA flap of size 288 cm. This patient had a minor loss of SSG over the donor site. ATA, anterior tibial artery; PTA, posterior tibial artery; PA, peroneal artery.

Fig. 6

Series of cases where islanded reverse peroneal artery was done for dorsum of foot defects in patients including pediatric age group subjects.

Fig. 7

( A - D ) Case of road traffic accident with the patient sustain injury to plantar surfaces of both feet following which RSA flap was done for right foot and RPA flap was done for the left foot. Postoperative result in the bottom picture. RPA, reverse peroneal artery; RSA, reverse sural artery flap.