The Peroneus Brevis muscle flap for distal third tibia reconstruction in burns and trauma – a non-microsurgical and expeditious technique offering rapid wound healing of a complex wound.

Published Date: 04th May 2022

Publication Authors: Cappuyns L, Gurusinghe D, Bell D, Shokrollahi K

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf

Introduction
Reconstructive options for defects of the distal third of the tibia are often limited, challenging and cited as requiring free tissue transfer. Local options can be used where the zone of injury allows. Full thickness burns to the anterior tibia quite often result in exposure of the tibia. Not all burn patients are suitable for microsurgical reconstruction for a range of reasons and therefore local options need to be explored. The Peroneus Brevis (PB) is a thin fusiform muscle in the lateral compartment of the leg which contributes to plantarflexion and eversion of the foot (figure 1). It is deep and anterior to the Peroneus Longus (PL) and is innervated by the peroneal nerve. The PB receives blood supply from all major leg vessels with an average of 4 perforators. The dominant, proximal pedicle is from the peroneal artery. Presence of an axial vessel running through the length of the muscle and connecting all source arteries suggests this muscle is a type VI muscle flap rather than type II or IV. With these perforators it can be transposed on proximal or distal pivot points. Donor site is acceptable and functional deficit minimal if peroneus longus is intact.

Aim
We demonstrate in detail the technique and use of this flap with subsequent successful outcome in a challenging case.

Conclusions
The Peroneus Brevis flap offers a relatively straightforward reconstructive option that can allow rapid healing of exposed bone in the distal third of the tibia without microsurgery. It has:

• low complexity •relatively short operating time
• minimal donor site morbidity
• No appreciable loss of contour
• no loss of ankle stability

All these features make it particularly suitable for patients with extensive burns who have contra-indications to free flap reconstruction. This technique would also be suitable in low resource settings where microsurgical facilities are lacking.

 

Cappuyns, L; Gurusinghe, D; Bell, D; Shokrollahi, K. (2022). The Peroneus Brevis muscle flap for distal third tibia reconstruction in burns and trauma – a non-microsurgical and expeditious technique offering rapid wound healing of a complex wound. Conference poster from British Burns Association Annual Meeting, 4th-6th May 2022.

 

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