Restoration of Distal Third Leg and Heel Soft Tissue Defects Using Local Muscle Flaps

Al Shahat, Osama; Abdel Mooktader, Magdy; Nasef, Mahmoud

doi:10.21608/ejprs.2018.215069

Restoration of Distal Third Leg and Heel Soft Tissue Defects Using Local Muscle Flaps

Document Type : Original Article

Authors

The Department of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/ejprs.2018.215069

Abstract

Background: Wound coverage of exposed lower third
tibia and ankle region remains a difficult task. Muscle flaps
are preferred for infected wounds especially where there are
exposed bone, joint and/or tendons.
Patients and Methods: This study includes 60 patients
with soft tissue defects at the distal third of leg. The study
duration was from April 2014 to April 2016. Cases in this
study were classified into two groups. Flap selection was
random. Group (A) include 30 patients reconstructed by
distally based peroneus brevis muscle flap. Group (B) include
30 patients reconstructed by distally based medial hemisoleus
muscle. Routine investigations included full laboratory investigations
and plain X-rays. Patients were operated under
regional or general anesthesia. Flap was assessed daily and
first dressing was done on day five of surgery. Patients were
discharged once flap and split skin grafting were healthy on
assessment after first dressing and subsequent dressings.
Patients were followed up twice weekly for the first month
and then once a month for six months.
Results: Group (A): Mean age 41 year, 29 cases male and
one case female. Site of the soft tissue defect: 14 case at the
lateral malleolus, 2 cases at the medial malleolus, 9 cases for
exposed tendoachillies, 4 cases at the anterior part of the ankle
joint and one case at the peritibial part of the distal third leg.
Size of the defect width rang from 3cm to 10cm and length
rang from 3cm to 12cm. Splitting of the muscle was done for
7 patients to increase its width and 23 case non splitting.
Complications: Only flap necrosis in one case need other
procedure for reconstruction and complete successful in 29
case. Group (B): Mean age 41 year, 28 case male and 2 cases
female. Site of the defect: 16 case at the medial malleolus
and 14 cases at the peritibial part of distal third leg. Size of
the defect width rang from 3cm to 7cm and length from 3cm
to 10cm. Complication: Flap failure occurred in 11 case and
complete successful in 19 cases.
Conclusion: Local muscle flaps is areliable method for
reconstruction of soft tissue defects at the distal third of the
leg.

Keywords

Main Subjects

Lower extremity and foot

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