MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb

F. Barbera, F. Lorenzetti, R. Marsili, M. Ragoni, A. Lisa, V. Zampa, M. Pantaloni

Research output: Contribution to journalArticlepeer-review


Background The distally based peroneus brevis muscle flap has proved to be a simple solution for small- to moderate-sized wounds of the lower limb. The length of the muscle belly suitable for coverage is a crucial parameter. In this study, we evaluated the capability of 3D MRI of the lower limb to measure it preoperatively. Methods Between 2008 and 2017, 32 patients with lower limb defects underwent preoperative MRI to measure the peroneus brevis muscle length. All patients underwent reconstruction, and the muscle was measured again intraoperatively during surgical dissection. Surgical measurements were then compared to the MRI ones. Results MRI measures of the peroneus brevis muscle belly ranged from 9 to 21 cm (μ = 14.44 ± 3.43 cm), and intraoperative measures ranged from 9 to 20 cm (μ = 14.2 ± 2.3 cm). Thirty of 32 intraoperative measures corresponded to the MRI ones (variation = ± 1 cm, r = 0.92, p = 0.002). One patient showed an intraoperative muscle length 3 cm shorter than the MRI measure, and another patient had intraoperative muscle length 3 cm longer than the MRI one. All flaps survived, and no secondary local flap coverage was required, with no flap-related complication, limited donor site morbidity, and acceptable patient discomfort. Conclusions The reverse peroneus brevis muscle flap is a versatile alternative to free flap reconstruction in small- to moderate-sized defects of the lower limb. Preoperative 3D MRI is accurate to evaluate the anatomy of the muscle when performed by an expert radiologist. In our experience, it should become part of preoperative workup before performing a peroneus brevis flap procedure. © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons
Original languageEnglish
Pages (from-to)1563-1570
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number11
Publication statusPublished - 2017


  • Distally based peroneus brevis flap
  • Lower leg reconstruction
  • Magnetic resonance
  • Preoperative planning
  • Reverse flow
  • adult
  • aged
  • Article
  • calcaneus
  • clinical article
  • evidence based practice
  • female
  • human
  • intraoperative period
  • lateral malleolus
  • male
  • medial malleolus
  • muscle flap
  • muscle length
  • nuclear magnetic resonance imaging
  • operation duration
  • outcome assessment
  • patient comfort
  • peroneus brevis muscle
  • peroneus muscle
  • preoperative evaluation
  • priority journal
  • reconstructive surgery
  • anatomy and histology
  • follow up
  • Leg Injuries
  • middle aged
  • preoperative period
  • procedures
  • retrospective study
  • skeletal muscle
  • surgical flaps
  • time factor
  • transplantation
  • very elderly
  • young adult
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Muscle, Skeletal
  • Preoperative Period
  • Reconstructive Surgical Procedures
  • Retrospective Studies
  • Surgical Flaps
  • Time Factors
  • Young Adult


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