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

Abstract

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.

Soleus muscle flap for the coverage of pre-tibial defect of middle third of leg

“…They work outside and travel frequently and more susceptible to injury usually from road traffic accidents (RTA). This picture is similar to the study of Pu (2006) and Chowdhury et al (2008), where mean age was 37 years and 37.5 years respectively. 34,44 In the study of Caudle & Stern (1987), the age group ranged between 17years to 80 years.…”

“…Chittoria & Mishra (2000) reported 5% partial flap necrosis. 13,20 Regarding over all post-operative complications, this study shows 4 cases of flap loss of variable dimension. These 4 patients also had associated skin graft of variable percentage.…”

“…More of the flap surgery were done between 1-2 weeks. In the study of Pu (2006) and Shamsuzzaman et al (2010), all flap surgery were done within 10 days and 5 days of initial trauma respectively. 13,15 Pollak et al (2000) reconstructed most of the flap within 7 days of surgery.…”

“…3 In the study of Kaukmann et al (2004) partial necrosis in one and flap failure in on patient (out of 12 patients), and that of Neale et al (1982) were 8 and 5 respectively (out of 71 patients). 18,19 In the study of Pu (2006), one patient developed flap necrosis (out of 14 patients) and was treated by debridement and flap advancement. Chittoria & Mishra (2000) reported 5% partial flap necrosis.…”

How to get the most out of your gastrocnemius and soleus flaps

“…17 The medial hemisoleus flap in isolation has limited donor site morbidity because plantarflexion strength is maintained, especially in the case of a proximally based medial hemisoleus flap where the divided medial tendon is sutured to the intact lateral soleus muscle. 14,22,23 The literature also supports that the combination of the medial gastrocnemius flap and soleus flap does not result in donor site morbidity. Ong, et al demonstrated that all 10 of their patients achieved full weight-bearing and function as they could all perform activities of daily living, ambulate independently, and climb stairs.…”