Physician's Resources: An Introduction to Lower Limb Muscle Flaps and Reconstruction: A Cadaveric Atlas

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There have been significant technological advancements over the past several decades to allow for intricate reconstructive surgical options. A large portion of the research has been dedicated to plastic reconstruction of the head and neck, as well as torso and upper extremity. Very little is written regarding lower extremity reconstruction, and in particular the use of muscular flaps.

There is a lack of knowledge within the Lower Extremity Specialist communities regarding these particular lower limb muscle flaps. The limitations are two fold: there is a lack of exposure, research and training early on in one’s career. But there is also an intimidation factor related to these larger surgical approaches.

Edgardo Rodriguez-Collazo, DPM and Christopher Bibbo, DO have been at the forefront of this lower limb reconstructive era with the debut of the reverse Peroneus Brevis muscle flap in the Journal of Foot and Ankle Surgery in 2013. Dr. Rodriguez has since advanced his surgical skills and perfected several other lower extremity musculocutaneous flaps in the meantime. It has been Dr. Rodriguez’ vision all the while to increase the exposure of this surgical option to all interested surgeons. He has done so through countless cadaveric dissections, lectures, and a yearly hands-on Chicago Lower Extremity Surgical Symposium.

We hope this E-book provides an introduction to a new a powerful technique for lower limb reconstruction.


The information set forth within this E-book is a personal approach used by the principle author. While it has proven to be innovative, and successful in limb salvage, the techniques have been cultivated over several years of surgical practice. The authors do not assume any liability for any injury and/or damages incurred as a result of reading and following protocols within this document. Medical research is also constantly evolving, and it is the reader’s digression to check the most current data available regarding lower extremity advances.

Table of Contents

  • Classification Systems Page 1
  • Preoperative Protocol Page 6
  • Intraoperative Protocol Page 10
  • Peroneus Brevis Muscle Flap Page 13
  • Medial Soleus Muscle Flap Page 22
  • Muscle Flap Transposition Page 35
  • Wound Closure Considerations Page 40
  • Other Muscle Flap Protocols Page 46
  • Peroneus Brevis Muscle Flap Case Study Page 53
  • References Page 62

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  1. American Society of Plastic Surgeons. Evidence-based Clinical Practice Guideline. Chronic Wounds of the lower extremity. 2007. [September 2012].
  2. Masquelet AC and Gilbert A. An Atlas of Flaps of the Musculoskeletal System. London. Martin Dunitz: 2001.
  3. Orgill DP and Pribaz JJ. Reverse Peroneal Flaps: Two surgical approaches. Ann Plast Surg 1994; 33: 17-22.
  4. Rodriguez-Collazo ER, Bibbo C, Mechell RJ and Arendt A. The reverse peroneus brevis muscle flap for ankle wound coverage. J Foot Ankle Surg 2013; 52(4): 543-546.
  5. Rodriguez-Collazo ER, Weiland J, Manson TS and Jones A. Peroneus Brevis muscle flap and the use of INTEGRA® Wound Matrix and Split Thickness Skin Graft in the treatment of Full Thickness Ulcerations: Case Reports and Technique Guide. Ortho and Rheum Open Access J 2015; 1(4): 1-5.