Reverse Peroneal Artery Flap for Large Heel and Sole Defects: A Reliable Coverage

BACKGROUND Large soft tissue defects of ankle and foot always have been challenging to reconstruct. Reverse sural flaps, free flaps have been used for this problem with variable success. Reverse peroneal artery flap is an option to use with reliability without microvascular repair. Connections of peroneal artery around talus and ankle joint are deep and reliable with anterior tibial and posterior tibial artery.  Arterial inflow and venous drainage improved with including short saphenous vein and reverse sural artery in the flap. METHODS Ten patients with large defects around heel underwent reconstruction with (RPAF) reverse peroneal artery flap (pedicled) over a period of 2 years. Final inset given after 18-21 days of primary surgery.  The mean age of these patients was 45 years. RESULTS Of the 10 flaps, all showed complete survival without even marginal necrosis. Two patients had minor donor site problems that settled with conservative management. CONCLUSION RPAF is a very reliable flap for the coverage of large soft tissue defects of the heel and sole. Large defects can be reconstructed without microvascular surgery and without compromising major vessel of foot region. If some experience with perforator flaps and free fibula is there then RPAF is easy to execute with reliability.