The reverse extended peroneal artery perforator flap for soft tissue defects of the ankle and foot.

Objective To investigate the operative technique and clinical results of repairing soft tissue defects of the ankle and foot with reverse extended peroneal artery perforator flap. Methods From April 2007 to February 2008, 10 patients, 7 men and 3 women, were treated with this technique, with an av-erage age of 34.2 years (ranged from 8 to 52 years). The initial wounds were caused by trauma, burn injury and chronic ulcer, with bone and/or tendon exposure. The flap was designed overlying the course of the per-oneal artery, which corresponds to the palpable posterior border of the fibula when mapped to the surface.The flap was raised by dividing the peroneal artery and veins proximally and elevating them distally, which covered for the defects of the ankle and foot. The pivot point was placed at the level of the ankle joint dis-tally. Thus the flap was completely isolated on its vascular pedicle, which by design and dissection was long enough permit tension free transposition of the attached soft tissue into the defect. The flaps were designed with the size measuring 10 cm×5 cm to 25 cm×15 cm. The pure vascular pediele of the flap was 6 cm to 17 cm in length, including the peroneal vessels and one to three perforator branches. Results All 10 flaps sur-vived after surgery. Partial inadequate venous return and distal superficial necrosis happened in only 1 case,which also got secondary healing by changing dressing and anti-infective therapy. The donor sites reached primary healing completely. After following up for 5-14 months, the appearance and function of the flaps were all satisfactory, and no influence to ambulation was found. Conclusion The reverse extended peroneal artery perforator flap supplied by a pure vascular pedicle can be a good alternative for reconstruction of the ankle and foot. The flap, with a long and thin pure vascular pedicle, could provide good texture and contour matching the recipient area. Key words: Surgical flaps;  Foot;  Soft tissue injuries