Reconstruction of distal hand and foot defects with the free proximal peroneal artery perforator flap

Mario F. Scaglioni, Yur Ren Kuo, Yen Chou Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

19 Scopus citations


Background The proximal peroneal artery perforator (PPAP) flap is a reliable, thin fasciocutaneous flap. The purpose of this article was to report our experience with the use of free PPAP flaps for reconstruction of defects of the distal hand and foot. Patients and Methods From November 2012 to September 2013, 9 patients received reconstruction with 10 free PPAP flaps. The defect locations included the big toe (2 cases), metatarsophalangeal joint (5 cases), dorsal finger (2 cases) and volar finger (1 case). Flaps were raised based on proximal peroneal perforator vessels without sacrificing the peroneal artery. The first dorsal metatarsal artery (5 cases) and digital artery (5 cases) were dissected as recipient vessels. Results The flap sizes varied from 2.5 x 2 cm to 9 x 5 cm. All of flaps were survival after surgery. One flap suffered from venous thrombosis and was successfully salvaged by performing a venous thrombectomy and vein graft. The donor sites were all primarily closed with minimal morbidities. Follow-up observations were conducted for 7 to 20 months, and all patients had good functional recovery with satisfying cosmetic results. Conclusion Perforators arising from the peroneal artery in the proximal lateral leg can be used to design small, pliable fasciocutaneous flaps. Although the pedicle is short, the vessel diameter is adequate for microvascular anastomosis to the distal foot and hand recipient vessels. The free PPAP flap may be a good option for reconstructing distal hand and foot defects.

Original languageEnglish
Pages (from-to)183-190
Number of pages8
Issue number3
StatePublished - 01 03 2016

Bibliographical note

Publisher Copyright:
© 2014 Wiley Periodicals, Inc.


  • distal hand and foot defects
  • free flap
  • proximal peroneal artery perforator flap


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