The myocutaneous long peroneal flap: An anatomical study and its clinical application

Published:August 19, 2020DOI:
      The knee joint and its surrounding are prone to complications after trauma or elective surgery because of its paucity of pliable soft tissue with higher risk of defects or infections. Despite the well-known different techniques
      • Rao A.J.
      • et al.
      Soft tissue reconstruction and flap coverage for revision total knee arthroplasty.
      as first line treatment in reconstructive surgery, this area nevertheless remains a challenge. The aim of this study was to develop a solution to close small to medium defects of this area with minimal use of extra needed split skin grafts especially those after failed knee surgery where the gastrocnemius muscle has to be spared for revision endoprosthesis implantation in a setting without microscope or in elderly in poor physical state with already used gastrocnemius muscle flap. We performed primarily cadaver dissections to clarify vascularity and size of the skin island of the mcLPF and secondary to develop a standard operation protocol. First, we marked the anatomical landmarks of the fibula and centered the planned skin island over its proximal half and checked the primary closure with a pinch test. After incision of the skin island, the peroneal compartment was opened distally, identifying the lower part of the long peroneal muscle at the site of the peroneal tendon junction. After carefully dissection of the muscle from distal to proximal the peroneal nerve and its two branches were identified in combination with its most proximal vascular muscle pedicle. This vascular pedicle acts as the pivot point of the whole flap. We then dissected the skin island from lateral to central towards the skin perforators which were almost constantly located on a vertical line in the middle of the muscle. The length of the five cadaveric skin paddles was 19–24 cm (mean 21,2 cm), width was 3,5–4,5 cm (mean 4,1 cm) and the number of skin perforators 3–5 (mean 3,8 cm) (Figure 1).
      Fig 1
      Figure 1Cadaver dissection which shows overall design with its anatomic landmarks, position of the pedicle (in average 4 cm distal of the fibular head), skin perforators and the possible range of motion of the flap (flap size 20 × 4 cm).
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