Repair of skin and soft tissue defects at ankle and donor site with relaying reversed peroneal artery perforator flaps

Objective To investigate the clinical effect of relaying reversed peroneal artery perforator flaps in repairing skin and soft tissue defects at ankle and donor site. Methods A retrospective case series study was conducted on the clinical data of 23 cases of skin and soft tissue defects at ankle and donor site from September 2015 to May 2017. There were 16 males and seven females, with an average age of 35 years (range, 18-69 years). The soft tissue defects of ankle ranged from 4.0 cm×4.0 cm to 11.0 cm×7.0 cm. The distal perforator flap of the peroneal artery was firstly cut and used to repair the soft tissue defect of the ankle. The proximal perforator flap of the peroneal artery was used to repair the first donor site, and the second donor site was directly sutured at stage I. The perforator flap area ranges of the distal and the proximal perforator of the peroneal artery were 6.0 cm×5.0 cm to 14.0 cm×8.0 cm and 7.5 cm×4.0 cm to 14.0 cm×5.0 cm, respectively. The shape of recipient area and donor area were observed. The clinical effects were evaluated by American Orthopedic Foot and Ankle Association (AOFAS) score and Weber two-point discrimination test. Results All patients were followed up for 6-19 months (mean, 12 months). One case had partial necrosis of distal skin of ankle flap after operation and recovered 2 weeks after dressing change. All the other flaps survived smoothly in the first stage. The first donor site had no sunken area or rupture. Some linear scar remained at the second donor site, which did not affect the overall appearance. The flaps were smooth in appearance, good in texture, and close to normal color. The AOFAS score of the foot was 95-98 points, and the distance of two-point discrimination of flaps ranged from 8 to 10 mm. Conclusions The relaying reversed peroneal artery perforator flap has abundant blood supply, and the operation site is located at the lateral crural region, without sacrificing the main artery. It can improve the appearance and function of the first donor area while repairing the soft tissue defect of the ankle. Key words: Soft tissue injuries; Surgical flaps; Peroneal artery perforator