Anatomic Basis of Local Muscle Flaps in the Distal Third of the Leg

Hughes, Lowell A; Mahoney, James

doi:10.1097/00006534-199311000-00023

Cited by 48 publications

(29 citation statements)

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“…The use of proximally based peroneus brevis as a pedicled muscle flap was first described by Pers and Medgyesi [26]. In 2001, Eren et al described the use of the distally based peroneus brevis flap for reconstruction around the ankle [3].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Thammannagowda

Ashish

Mudukappa

et al. 2014

ISRN Plastic Surgery

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Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Defects at this site will often require flap cover. Free flap is ideal for these defects and gives good results but with its own limitations. The reverse sural artery flap (RSAF) and distal peroneus brevis flap (DPBF) have gained popularity for lower third leg defects among surgeons. We did a retrospective study on 64 patients admitted between 2011 and 2013 with posttraumatic moderate size defects of lower onethird leg who underwent RSAFs and DPBFs. These patients were followed up in the immediate and late postoperative period for complications and outcome assessment. The average surface area covered by DPBF was 27 cm 2 and by RSAF was 38 cm 2 . Both flaps gave a good functional outcome. DPBF has better aesthetic appearance at donor site and recipient site, with the advantages of ease of surgery, speedy recovery, less hospital stay, and no donor site morbidity; DPBFs appear to be a preferred choice for moderate size lower third leg defects. RSAFs should be chosen over DPBFs for defects in medial malleolus and larger size defects.

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Section: Discussionmentioning

confidence: 99%

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Thammannagowda

Ashish

Mudukappa

et al. 2014

ISRN Plastic Surgery

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“…This constant feature makes the medial part of the muscle (medial hemisoleus) reliable as a proximally based flap if some of these perforators can be preserved. [5][6][7] Based on the previous anatomic studies, 4 -7 the author has used the proximally based medial hemisoleus muscle flap for reconstruction of an open tibial wound in the junction of the middle and distal thirds of the leg. Once the medial half of the soleus muscle is identified and dissected freely to the level just above the junction between the middle and distal thirds of the tibia, any perforators from the posterior tibial vessels to the medial half of the soleus muscle adjacent to the junction of the middle and distal thirds of the leg should be preserved while allowing adequate arc of flap rotation to cover a distal tibial wound.…”

Section: Discussionmentioning

confidence: 99%

“…This study reports the author's clinical experience using the proximally based medial hemisoleus muscle flap for soft-tissue coverage of an open tibial wound in the junction of the middle and distal thirds of the leg. Based on more recent anatomic studies, [5][6][7] several modifications of the surgical techniques in flap dissection are described. With an application of surgical techniques refined by the author, the medial hemisoleus muscle flap can be a reliable local option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg.…”

mentioning

confidence: 99%

Soft-Tissue Coverage of an Open Tibial Wound in the Junction of the Middle and Distal Thirds of the Leg With the Medial Hemisoleus Muscle Flap

2006

Annals of Plastic Surgery

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A relatively simple but reliable option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg has never been determined. In this series, the author reports his clinical experience utilizing the medial hemisoleus muscle flap as a local reconstructive option for management of this unique clinical problem. Over the past 2 years, 14 patients underwent a soft-tissue reconstruction of an open tibial wound (4 x 3 to 10 x 5 cm) in the junction of the middle and distal thirds of the leg with the proximally based medial hemisoleus muscle flap. Only the medial half of the soleus muscle was elevated, with attention to preserving critical perforators from the posterior tibial vessels to the flap while allowing adequate arc of flap rotation to cover the exposed fracture site and hardware. All patients were followed for up to 2 years. Only 1 patient developed insignificant distal flap necrosis and was treated with debridement and flap readvancement. All patients had primary healing of their wounds, reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Therefore, the medial hemisoleus muscle flap described by the author can be a reliable local option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg with good outcome and minimal morbidity.

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“…This method allows the primary treatment of skin defects and, in some cases, also of the bone damage. Therefore, it is indicated as an aid in the treatment of varicose ulcers, fractures, osteomyelitis and pseudoarthrosis with exposed bone or scar adherent to the bone 1,[18][19][20][21][22][23][24][25][26][27][28][29][30] . Knowledge of anatomy and surgical technique make the transposition of these muscles a feasible procedure for surgeon, who, with practice, starts to spend less time in the procedure than with other techniques, such as microsurgical flaps.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Use of local muscle flaps to cover leg bone exposures

Dávila¹,

Franco

d'Avila

et al. 2014

Rev. Col. Bras. Cir.

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Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

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Anatomic Basis of Local Muscle Flaps in the Distal Third of the Leg

Cited by 48 publications

References 0 publications

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Soft-Tissue Coverage of an Open Tibial Wound in the Junction of the Middle and Distal Thirds of the Leg With the Medial Hemisoleus Muscle Flap

Use of local muscle flaps to cover leg bone exposures

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