The Reversed Flow Hemisoleus Propeller Muscle Flap

Abstract

Background Soleus muscle flap can be used in different modifications to reconstruct lower limb defects. It can be proximally based, distally based, island or reversed flow flap. The first description of the soleus muscle as an island flap supplied by one distal perforator was reported by Yajima et al ( Plast Reconstr Surg . 1995;96:1162–1168). However, its use as a propeller flap supplied by the distal perforators and rotated for more than 90 degrees was not described yet. Obejectives The aims of the study are to study the detailed vascular anatomy of the distal perforators of the soleus muscle flap and to demonstrate the applicability of using it as a propeller flap. Patients and Methods A total number of 42 patients were included in this study. These patients had various distal leg and foot defects. All patients were assessed preoperatively by Doppler study and computed tomography angiography to define the vascular status of the leg. The muscle was raised as a reversed flow flap, based on 1 or more distal perforators and its feeding vessel (posterior tibial artery) after being dissected and divided proximally. The muscle was rotated for more than 90 degrees to reach distal leg defects and approximately 180 degrees to reach the foot defects. Results All flaps survived completely with good and durable coverage. The vascularity of the limb was not affected in all patients. There was no functional donor site morbidity. Conclusions The reversed flow hemisoleus muscle flap supplied by the distal perforators and the posterior tibial artery has a great arc of rotation that can cover all distal leg, ankle, and foot defects. Therefore, it can be used as alternative to free flap in lower extremity reconstruction. A new nomenclature is suggested for this flap which is the propeller hemisoleus muscle flap.

Response to “The Reversed Flow Hemisoleus Propeller Muscle Flap”

“…In this article, the authors report on their experience using a bipedicled flap to decrease the wound size and facilitate another concurrent flap. 1 This anatomical area is particularly sensitive to trauma, because of the thinness of the skin tissue with exposure, or even frequent nerve, bone, or vascular injuries. Free flaps can provide significant skin coverage but can be risky because of the local defect, the characteristics and history of the patient, and, sometimes, the difficult access to microsurgery in some centers.…”

“…Saleh et al 1 advocate that, to their knowledge, the term propeller flap has never been applied to any muscle flap; moreover, they describe such flap as a newly described one that shares the original concept of the “propeller flaps,” as it can rotate over its axis for 90 to 180 degrees to cover a defect.…”

“…Not by chance, in 10 of 42 patients, Saleh et al 1 performed an interposition saphenous vein graft from the contralateral healthy limb to ensure blood supply to the foot.…”