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

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.