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Correspondence: Akil Fazal Section of Orthopedics, Department of Surgery, Aga Khan University, PO Box 3500, Stadium Road, Karachi 74800, Pakistan Tel +92 21 486 4350 Fax +92 21 493 4294 Email masf2@yahoo.com Background: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case series, we present our experience of the peroneal island pedicled flap for reconstruction of lower extremity wounds. Methods: Records of 18 cases of peroneal island flap admitted consecutively to the Section of Orthopedics at Aga Khan University Hospital from January 1996 to December of 2009 were studied and their outcomes determined. Results: The most common indication for coverage was open wounds due to a road traffic accident (n = 10), followed by burns (n = 3). The most common area exposed was the lower third of the leg followed by the middle third. The tibia was exposed in 11 patients. The flaps ranged in size from 35 cm to over 200 cm. In 13 patients, the flaps healed uneventfully, while in the remaining five there was partial flap necrosis. In four of the latter patients, the residual wound healed with conservative measures only, but the fifth patient required further surgery to achieve acceptable coverage. Conclusion: The peroneal artery flap appears to be a simple, useful, and reliable flap in the armamentarium of the surgeon when planning soft tissue coverage of the lower extremity.

Peroneal island flap for wound coverage in complex injuries of the lower extremity