MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb * Federico Barbera a,b, *, Fulvio Lorenzetti a , Ricccardo Marsili a , Matteo Ragoni a , Andrea Lisa d , Virna Zampa c , Marcello Pantaloni a a Plastic and Reconstructive Surgery Unit, University of Pisa, Santa Chiara Hospital, Pisa, Italy b Scuola Superiore Sant’Anna di Studi Universitari e Perfezionamento, Pisa, Italy c Diagnostic Radiology Department, University of Pisa, Italy d Humanitas Research Hospital, University of Milan, Italy Received 30 November 2016; accepted 18 June 2017 KEYWORDS Distally based peroneus brevis flap; Magnetic resonance; Reverse flow; Preoperative planning; Lower leg reconstruction Summary 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 mus- cle 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 measure- ments were then compared to the MRI ones. Results: MRI measures of the peroneus brevis muscle belly ranged from 9 to 21 cm ( m Z 14.44 Æ 3.43 cm), and intraoperative measures ranged from 9 to 20 cm (m Z 14.2 Æ 2.3 cm). Thirty of 32 intraoperative measures corresponded to the MRI ones (variation Z Æ 1 cm, r Z 0.92, p Z 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 * No financial support or benefits have been received by any author. We have not a relationship from any commercial source, which is related directly or indirectly to the scientific work. The principles outlined in the Declaration of Helsinki have been followed in this study. * Corresponding author. University of Pisa, Plastic and Reconstructive Surgery Unit, Santa Chiara Hospital, Piazza Martiri delle Liberta ` 33, 56127 Pisa, Italy. E-mail address: federico-barbera@libero.it (F. Barbera). + MODEL Please cite this article in press as: Barbera F, et al., MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb, Journal of Plastic, Reconstructive & Aesthetic Surgery (2017), http://dx.doi.org/10.1016/ j.bjps.2017.06.018 http://dx.doi.org/10.1016/j.bjps.2017.06.018 1748-6815/ª 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Journal of Plastic, Reconstructive & Aesthetic Surgery (2017) xx,1e8