Distally Based Peroneus Brevis Flap for Primary and Salvage Coverage of Distal Leg and Ankle Defects in a Resource-Limited Setting: A Report of Three Cases

Abstract

Distal leg and ankle defects with exposed bone are difficult to reconstruct, particularly after contaminated open injuries. Free tissue transfer is unavailable in many resource-limited hospitals, making reliable pedicled flaps essential. We report three adult men with Gustilo-Anderson type IIIB distal leg or ankle injuries treated with a distally based peroneus brevis muscle flap at a Sudanese teaching hospital. In the first patient, a 10×5 cm distal tibial defect after motorcycle trauma was covered immediately after debridement and external fixation, followed by skin grafting on postoperative day seven. In the second, a 7×5 cm lateral malleolar defect was covered on post-injury day four and grafted immediately. The third patient had a 13×6 cm donkey-bite/crush injury initially covered with a soleus flap; partial distal soleus flap loss re-exposed bone, and an adjunct peroneus brevis flap restored coverage on day six. All peroneus brevis flaps remained viable, all skin grafts took satisfactorily, and no clinically apparent deep infection or osteomyelitis was documented during six months of follow-up. All three limbs were salvaged. These cases show that the distally based peroneus brevis flap can provide both primary coverage and reactive salvage coverage for the selected distal leg and ankle defects when microsurgical reconstruction is unavailable.