Use of Soleus Muscle Flaps for Coverage of Distal Third Tibial Defects

ABSTRACT

The authors reviewed the outcome of 12 patients who underwent soleus flap reconstruction of distal third lower extremity defects. Nine of the 12 patients achieved a healed, stable wound; however, several flaps and multiple additional procedures were often required. One of the 12 patients experienced soleus flap loss and two of the patients required below-knee amputations. Failure of limb salvage was related to traumatic injuries or comorbid conditions such as peripheral vascular disease, smoking, and planned radiation. They conclude that these factors should be considered relative contraindications to the use of the soleus flap in the distal third of the leg, and that free flap coverage is the most reliable option for these high-risk patients.

KEYWORDS

Soleus - muscle flap - lower extremity reconstruction

REFERENCES

• 1 Mathes S, Nahai F. Reconstructive Surgery: Principles, Anatomy and Technique, 1st ed. New York; Churchill Livingstone 1997: 1473-1487
• 2 Hallock G G. Utility of both muscle and fascia flaps in severe lower extremity trauma.  J Trauma. 2000;  48 913-917
• 3 Jackson I T, Scheker L. Muscle and myocutaneous flaps on the lower limb.  Injury. 1982;  13 324-330
• 4 Hallock G G. Getting the most from the soleus muscle.  Ann Plast Surg. 1996;  36 139-146
• 5 Yajima H, Tamai S, Ishida H, Fukui A. Partial soleus muscle island flap transfer using minor pedicles from the posterior tibial vessels.  Plast Reconstr Surg. 1995;  96 1162-1168
• 6 Hughes L A, Mahoney J L. Anatomic basis of local muscle flaps in the distal third of the leg.  Plast Reconstr Surg. 1993;  92 1144-1154
• 7 Wright J K, Watkins R P. Use of the soleus muscle flap to cover part of the distal tibia.  Plast Reconstr Surg. 1981;  68 957-958
• 8 Beck J B, Stile F, Lineaweaver W. Reconsidering the soleus muscle flap for coverage of wounds of the distal third of the leg.  Ann Plast Surg. 2003;  50 631-635
• 9 Ladas C, Nicholson R, Ching V. The cross-leg soleus muscle flap.  Ann Plast Surg. 2000;  45 612-615
• 10 McCraw J B, Arnold P G. Soleus. In: McCraw JB, Arnold PG McCraw and Arnold's Atlas of Muscle and Musculocutaneous Flaps Norfolk, VA; Hampton Press Publishing 1986: 545-581
• 11 Hallock G G, Lutz D A, Osborne M A. Nonoperative estimation of the soleus musculotendinous junction using magnetic resonance imaging.  Plast Reconstr Surg. 1997;  100 896-899