Human cadaveric Study of Soleus Muscle arterial blood supply and its Application in peri-ankle Reconstruction

Abstract

Introduction: Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Aim of the work: study the anatomy of the various patterns of arterial supply to soleus muscle based on cadaveric dissection for its application as a pedicle flap for lower leg and peri-ankle reconstruction. Methodology: The study included 8 adult lower limbs from the Department of Anatomy at Faculty of medicine Al-Azhar University. The study duration was from May 2018 to May 2019. The branches of popliteal, posterior tibial and peroneal arteries were traced till their point of entry into the soleus muscle.These were considered as extra muscular branches(EMB) to the soleus. Results: Popliteal artery supplies the muscle by 1 perforator at 2 samples , 2 perforator branches at 3 samples and absent at 3 samples .Posterior tibial artery: supplies the muscle by not less than 4 perforators at 8 samples. Peroneal artery: supplies the Soleus muscle by 2 to 4 perforators according to our study 2 samples were supplied by 2 perforators , 4 samples were supplied by 3 perforators and 2 samples were supplied by 4 perforators Conclusion: The proximal 25 % of length of soleus received EMB from all the three arteries and hence a proximally based soleus muscle flap is better than distally based muscle flap. Recommendations: Doppler ultrasonography and angiography are useful for detection the actual location and size of soleus perforators.