Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects

Document Type : Original Article

Author

The Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt

Abstract

Background: Coverage of distal leg defects is quite challenging.
Usually, free tissue transfer is used for the reconstruction
of such defects. Lack of microsurgical team/setup < br />or patient contraindication to undergo a lengthy procedure
would divert the decision to local tissues for coverage typically
using local fasciocutaneous/propeller flaps or muscle flaps.
Also, those local flaps options would be the first choice for
relatively small defects, with plenty of healthy tissue available
for coverage. If a local fasciocutaneous flap is not feasible or
desired, the distally based medial hemisoleus flap is a common
reliable alternative for reconstruction of middle and/or distal
third leg defects of small to moderate size. In the current
series, relatively larger defects were successfully reconstructed
using this flap. Intraoperative confirmation of the adequacy
of the explored flap distal pedicle underly the reported satisfactory
flap survival rate.
Patients and Methods: The study enrolled 13 cases (12
male & 1 female) with distal and/or middle third leg defects.
Patients' age ranged from 12-51 years age (mean 37 years),
with defect sizes ranging from 3.5x5cm (17.5cm2) to 8x10cm
(80cm2) with a mean of 41cm2. Distally based medial hemisoleus
flap was used to reconstruct all cases, based on its
distal pedicle(s) from the posterior tibial vessels. A split
thickness skin graft was used to cover the muscle typically
one week later in a second procedure.
Results: All flaps survived completely except partialthickness
surficial flap necrosis in one case. This was conservatively
managed by debridement and later skin grafting.
All cases achieved complete healing of their wounds with
successful limb salvage.
Conclusions: Intraoperative confirmation of distal medial
hemisoleus flap pedicle would ensure better flap survival and
would allow safe reconstruction of moderately large distal
leg defects in selected cases with appropriate distal pedicle
size and location.

Keywords

Main Subjects

References

1- Marek C.A. and Pu L.L..: Refinements of free tissue
transfer for optimal outcome in lower extremity reconstruction.
Ann. Plast. Surg., 52: 270-275, 2004.
2- Swartz W.M. and Mears D.C.: The role of free-tissue
transfer in lower extremity reconstruction. Plast. Reconstr.
Surg., 76: 364-373, 1985.
3- Heller L. and Levin L.S.: Lower extremity microvascular
reconstruction. Plast. Reconstr. Surg., 108: 1029-1041,
2002.
4- Nazerali R.S. and Pu L.L.: Free tissue transfer to the
lower extremity: A paradigm shift in flap selection for
soft tissue reconstruction. Ann. Plast. Surg., 70: 419-422,
2013.
5- Pu L.L.: Soft-tissue reconstruction of an open tibial wound
in the distal third of the leg: A new treatment algorithm.
Ann. Plast. Surg., 58 (1): 78-83, 2007.
6- Thornton B.P., Rosenblum W.J. and Lee L.: Reconstruction
of limited soft-tissue defect with open tibial fracture in
the distal third of the leg. Ann. Plast. Surg., 54 (3): 276-
80, 2005.
7- Calderon W., Chang N. and Mathes S.J.: Comparison of
the effect of bacterial inoculation in musculocutaneous
and fasciocutaneous flaps. Plast. Reconstr. Surg., 77 (5):
785-94, 1986.
8- Chang N. and Mathes S.J.: Comparison of the effect of
bacterial inoculation in musculocutaneous and randompattern
flaps. Plast. Reconstr. Surg., 70 (1): 1-10, 1982.
218 Vol. 45, No. 4 / Distally Based Medial Hemisoleus Muscle Flap
9- Gosain A., Chang N., Mathes S., et al.: A study of the
relationship between blood flow and bacterial inoculation
in musculocutaneous and fasciocutaneous flaps. Plast.
Reconstr. Surg., 86 (6): 1152-63, 1990.
10- Salgado C.J., Mardini S., Jamali A.A., et al.: Muscle
versus nonmuscle flaps in the reconstruction of chronic
osteomyelitis defects. Plast. Reconstr. Surg., 118 (6):
1401-11, 2006.
11- Yazar S., Lin C.H., Lin Y.T., et al.: Outcome comparison
between free muscle and free fasciocutaneous flaps for
reconstruction of distal third and ankle traumatic open
tibial fractures. Plast. Reconstr. Surg., 117 (7): 2468-75,
2006.
12- Cho E.H., Shammas R.L., Carney M.J., et al.: Muscle
versus fasciocutaneous free flaps in lower extremity
traumatic reconstruction: A multicenter outcomes analysis.
Plast. Reconstr. Surg., 141 (1): 191-9, 2018.
13- Tobin G.R.: Hemisoleus and reversed hemisoleus flaps.
Plast. Reconstr. Surg., 76: 87-96, 1985.
14- Hassan K.M., Mohamed A.M. and Mohamed M.S.: Clinical
Evaluation of Peroneous Brevis Muscle Flap as a Reconstructive
Tool for Defects Around the Ankle. Egypt, J.
Plast. Reconstr. Surg., 43 (3): 557-564, 2019.
15- Pu L.L.: The reversed medial hemisoleus muscle flap and
its role in reconstruction of an open tibial wound in the
lower third of the leg. Ann. Plast. Surg., 56: 59-64, 2006.
16- Schierle C.F., Rawlani V., Galiano R.D., et al.: Improving
outcomes of the distally based hemisoleus flap: Principles
of angiosomes in flap design. Plast. Reconstr. Surg., 123:
1748-1754, 2009.
17- Houdek M.T., Wagner E.R., Wyles C.C., et al.: Reverse
medial hemisoleus flaps for coverage of distal third leg
wounds: A technical trick. J. Orthop. Trauma, 30 (4): 138-
42, 2016.
18- Unluer Z., Al-Ajam Y. and Al-Benna S.: Functional
outcome after reconstruction of traumatic soft tissue
defects in the lower half of the leg with distally based
medial hemisoleus muscle flaps. A case series and literature
review. Ann. Plast. Surg., 81: 468-471, 2018.
19- Rabbani M.J., Ata-ul-Haq, Riaz A., et al.: Distally based
medial hemisoleus flap: reliable option for distal tibial
wounds. J. Coll Physicians Surg. Pak., 28 (2): 129-32,
2018.
20- Mathes S.J. and Nahai F.: Classification of the vascular
anatomy of muscle: Experimental and clinical correlation.
Plast. Reconstr. Surg., 67: 177-87, 1981.
21- Hallock G.G.: Getting the most from the soleus muscle.
Ann. Plast. Surg., 36: 139-146, 1996.
22- Raveendran S.S. and Kumaragama K.G.: Arterial supply
of the soleus muscle: Anatomical study of fifty lower
limbs. Clin. Anat., 16: 248-252, 2003.
23- Park I.J., Sur Y.J. and You S.L.: Reconstruction of the
soft tissue defect on anteromedial surface of the leg using
medial hemisoleus flap. J. Korean Soc. Microsurg., 23:76-
81, 2014.
24- Pu L.L.: Further experience with the medial hemisoleus
muscle flap for soft-tissue coverage of a tibial wound in
the distal third of the leg. Plast. Reconstr. Surg., 121:
2024-2028, 2008

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