Reconstruction of distal third defects in the lower limb is a challenge that often requires microsurgical free tissue transfer. The authors introduce a peroneal artery perforator flap based on the deep descending branch for reconstruction of lateral malleolar defects. They present a cadaveric anatomical study of the perforator course, lumen diameter and surface markings as well as its implementation in five clinical cases. All flaps survived completely and three out of five donor sites were closed primarily. The advantage of using the deep descending branch perforator is a pivot point closer to the lateral malleolus, meaning a smaller flap can be raised and therefore a smaller donor defect. This is certainly not a first-line flap choice but may be a suitable option in patients with risk factors precluding free tissue transfer.
Descending branch peroneal artery perforator flap
Reviewed by Neil J Cahoon
Descending branch of the perforating branch of the peroneal artery perforator-based island flap for reconstruction of the lateral malleolus with minimal invasion.
