Strategies to Maximize the Success of the Distally Based Peroneus Brevis Muscle Flap: Lessons Learnt from the Experience in a Single Health care Center.

Lower limb reconstruction, particularly in the distal third, is challenging due to limited local flap options, poor skin laxity, and the direct exposure of critical structures such as bone and tendons due to the thin skin in the region. For larger defects, a microvascular free flap transfer is often required. For small to medium defects, the distally based peroneus brevis muscle flap is a viable option, though it may risk distal flap necrosis over the critical defect area. This study presents the authors' experience using this flap in 9 patients at a Singapore health care center. Key considerations include (1) modifications in situations where a perforator-based propeller flap is considered as an alternative option, (2) the use of intraoperative Indocyanine Green Near-Infrared Video Angiography to reduce necrosis risk, (3) employing negative pressure wound therapy, and (4) determining the optimal immobilization duration.