Reconstruction of Lower One Third Leg Defects in Single Vessel Lower Limb by Medial Hemisoleus Muscle Flap Based on Distal Posterior Tibial Artery Perforators

Abstract

Background: Crushing injuries of the lower 1/3 of thelower limb always represent a challenge for reconstruction.Reconstructive options diminish with the injury of one ormore of the major vessels of the lower limb. This is a revisitof distally based medial hemi-soleus muscle flap as a valuableoption in such reconstruction.Patients and Methods: 16 patients with skin loss overlower one third of leg of various causes had pre-operativeduplex done to detect affection of anterior tibial and/or peronealvessels and confirm patency of the posterior tibial vessels.CT angiography was done for confirmation. In case of one ortwo vessels affection, sparing the posterior tibial artery, thedefects in the distal one third of the leg were reconstructedby distally based hemi-soleus muscle flap; based on the distalperforators of the medial head of the soleus muscle from theposterior tibial artery.Results: The flap survived completely in twelve caseswith total loss in one patient, partial loss in two case and localrecurrence of the excised tumour in one case.Conclusion: The distally based medial hemi-soleus muscleflap is a very good option in reconstruction of problematiclower one third skin defects especially that associated withvascular injury other than the posterior tibial vessels.