Medial Hemisoleus Muscle Flap Research Articles

Exposed Distal Tibia Coverage by Reversed Soleus Muscle Flap: Our Experiences

Reconstruction of the exposed lower third tibia and ankle region remains a difficult task and a challenge for reconstructive surgeons. Microsurgical flaps have been the method of choice for this reconstruction, but in our hospital, we do not have equipment or a microsurgical-trained team for this type of procedure. Moreover, free muscle flaps have more risk of failure and sometimes the patient's clinical condition does not allow a more complex surgery in some cases. Local muscle flaps are preferred in these situations. MethodologyThis study was carried out in the Burn and Plastic Surgery Department, Rajshahi Medical College Hospital, Rajshahi from July 2015 to December 2021 on 100 patients ( 89 males and 11 females with ages ranging between 21 and 62 years). Patients with tibial defects in the distal third of the tibia which need soft tissue coverage were selected. ResultsOur study shows that reversed medial hemisoleus muscle flap had an excellent outcome with short surgical duration, easy implementation, excellent resolution, and low morbidity of the donor area. Moreover, preservation of the lateral portion is suitable for plantar flexion showing a long arc of rotation. ConclusionMedial hemisoleus muscle flap is a reliable option for the reconstruction of soft tissue defects with the exposed bone of the distal leg based on perforators of the posterior tibial artery. Careful flap dissection with preservation of as many perforators as possible is the key to success.

Proximally Based Medial Hemi-Soleus Muscle Flap Employed For Moderate-Sized Pretibial Defects of the Middle Third of the Leg

OBJECTIVES This study was undertaken to document the clinical indications and outcome of proximally based medial Hemi-soleus muscle flap for coverage of moderate-sized complex pretibial defects of the middle third of the leg. METHODOLOGY This descriptive case series was conducted at the Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Burn & Trauma Center, Hayatabad, Peshawar, over five years. (i.e., from November 01, 2016, to December 31, 2021). It included all adult patients of either gender whose complex pretibial wounds of the middle third leg were managed with proximally based medial Hemi-soleus muscle flaps. RESULTS The mean age was 31.40±9.83 years, ranging between 19-47 years. All the patients had complex post-traumatic defects secondary to road traffic accidents. There were 9(33.3%) patients with minor defects (i.e., measuring ≤2×2 cm2), whereas 18(66.6%) patients had medium-sized defects (i.e., ≥2×2 cm2 and ≤7×5 cm2). Their hospital stay ranged between 9-15 days with a mean stay of 11.92±3.1 days. All the flaps (100%) survived. Partial skin graft loss was encountered among three patients (n=3;11.1%). CONCLUSION The study provides a good evidence base regarding the usefulness of the flap in managing complex defects of the leg. It is recommended to carry out similar studies internationally. These should help improve our findings and come up with further refinements.

Early results of the distally based medial hemisoleus muscle flap in high-risk patients: A case series

The lower one-third of the leg, ankle, and posterior heel are devoid of robust soft tissue coverage. Coverage of exposed tendons, hardware, and bone can be challenging. The distally based medial hemisoleus flap is a viable option for soft tissue coverage. The medial hemisoleus flap is supplied by perforators from the posterior tibial artery. Complications of the flap are low, ranging around 8-20%; the most common complication is partial necrosis due to venous congestion. Patients with comorbidities are more prone to partial or complete flap loss and subsequent major amputation. The purpose of this study is to present a case series of medial hemisoleus flaps in high-risk patients with follow-up of 40-52 weeks. We present a case series of five multi-comorbid patients that underwent treatment of osteomyelitis for posterior heel wounds or chronic ankle wounds due to Charcot deformity. Patients were treated with surgical debridement, pathogen directed parenteral antibiotic therapy if indicated, deformity correction, if applicable, and distally based medial hemisoleus flap coverage of wounds. In contrast to free flaps, it allows for shorter operating time and does not necessitate microsurgical experience. The flap has a relatively low complication rate in the literature. In the setting of venous congestion and partial flap necrosis, this can often be managed with various techniques to prevent total flap loss. At follow-up of at least 40 weeks, the medial hemisoleus is a reliable procedure for soft tissue coverage of the lower leg, ankle, and posterior heel.

Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects

Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects

Distally Based Medial Hemisoleus Muscle Flap for reconstruction of distal and middle third leg defects.

Background: Coverage of distal leg defects is quite challenging. Usually, free tissue transfer is used for the reconstruction of such defects. Lack of microsurgical team/setup or patient contraindication to undergo a lengthy procedure would divert the decision to local tissues for coverage typically using local fasciocutaneous/propeller flaps or muscle flaps. Also, those local flaps options would be the first choice for relatively small defects, with plenty of healthy tissue available for coverage. If a local fasciocutaneous flap is not feasible or desired, the distally based medial hemisoleus flap is a common reliable alternative for reconstruction of middle and/or distal third leg defects of small to moderate size. In the current series, relatively larger defects were successfully reconstructed using this flap. Intraoperative confirmation of the adequacy of the explored flap distal pedicle underly the reported high flap survival rate. PATIENTS AND METHODS: The study enrolled 13 cases (12 male & 1 female) with distal and/or middle third leg defects. Patients' age ranged from 12–51 years age (mean 37 years), with defect sizes ranging from 3.5x5cm (17.5cm2) to 8x10cm (80cm2) with a mean of 41cm2. Distally based medial hemisoleus flap was used to reconstruct all cases, based on its distal pedicle(s) from the posterior tibial vessels. A split thickness skin graft was used to cover the muscle typically one week later in a second procedure. RESULTS: All flaps survived completely except partial-thickness surficial flap necrosis in one case. This was conservatively managed by debridement and later skin grafting. All cases achieved complete healing of their wounds with successful limb salvage. CONCLUSIONS: Intraoperative confirmation of distal medial hemisoleus flap pedicle would ensure better flap survival and would allow safe reconstruction of moderately large distal leg defects in selected cases with appropriate distal pedicle size and location.

Pedicled bridge transplantation for soft tissue defects at the contrallateral leg with medial leg skin flap and medial hemi-soleus muscle flap

Objective To evaluate the pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap for the treatment of soft tissue defects at the contrallateral leg. Methods Between January of 2012 and January of 2016, 8 patients with soft tissue defects at the leg were treated at Department of Orthopedic Surgery, Hand and Foot Surgery Hospital of Lanzhou. They were 5 men and 3 women, aged from 19 to 50 years (mean, 35 years). All of them were treated by bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap pedicled with posterior tibial artery. The size of the defects ranged from 10 cm×9 cm to 13 cm×8 cm. The immediate coverage of the muscle flaps and vessel pedicle was repaired by a meshed split-thickness skin graft. The donor site was closed directly. The therapeutic efficacy was assessed at the final follow-up according to the criteria by Iowa for tibial fractures. Results All the skin flaps and muscle flaps survived without any vascular crisis. One case developed necrosis of small skin graft at the distal muscle flap which spontaneously healed after dressing change for 2 weeks. Their follow-up ranged from 2.5 to 4.5 years (mean, 3.8 years). A good contour was confirmed at the recipient area. By the Iowa criteria at the final follow-up, 3 cases were excellent, 4 good and one fair. Conclusion Pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap is a good treatment for soft tissue defects at the contrallateral leg which has only one major blood vessel, reducing damage to the donor site. Key words: Leg injuries; Soft tissue injuries; Surgical Flaps; Muscle flap

Reversed Hemisoleus Flap for Traumatic Wound Coverage in the Distal Third of the Leg

AbstractBackground: Reconstruction of soft tissue defects of the distal third leg are common challenging therapeutic problems with significant long-term morbidity. Treatment options include cross leg flaps, local flaps (as muscle flaps and fasciocutaneous flaps) and the free vascularized flaps.Aim of Study: The aim of this study is to evaluate the clinical outcome of reversed hemisoleus muscle flap in cov-erage of traumatic soft tissue defects in the distal third of the leg.Patients and Methods: In this prospective study, we present 21 patients with traumatic soft tissue defects in the distal third leg with exposure of bone, tendons and neurovas-cular structures, managed by reversed medial hemisoleus muscle flap. Clinical and radiological data were analyzed.Results: The outcome of the flap surgery was evaluated after at least 6 months follow-up on the basis of flap survival, graft intake, functional gain and donor site morbidity [1]. Clinical results were graded as excellent, good, fair as follows: 13 showed excellent results (61.9%), 7 showed good survival (33.3%) and 1 flap was graded as fair (4.8%) with no poor results. The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Accordingly, satisfactory results were found in 20 patients (95.2%), and the unsatisfactory results were found in 1 patient (4.8%) with reliable soft-tissue cov-erage and complete wound healing in all patients.Conclusion: This study shows that reversed medial hem-isoleus muscle flap is a reliable reconstructive option for traumatic soft tissue defects on the medial side of the distal tibia in selected cases.

Medial Hemisoleus Muscle Flap in Reconstruction of Soft Tissue Defects of Lower Leg

Background: Reconstruction of lower leg represents a challenge task for plastic surgeons. Although microsurgical flaps have been the golden choice for this reconstruction, many hospitals do not have equipment or microsurgical staff trained for this type of procedure. Aim: The objective of the current study is to evaluate of clinic applicability and functional outcome results of medial hemisoleus muscle as a reconstructive flap modality in lower third leg soft tissue defect. This includes clinical study comparison between two surgical modalities of hemisoleus muscle Hap elevation. Methodology: This study was conducted in Plastic Surgery Department, Aswan University Hospital from May 2017 to August 2018. It was a descriptive study including 30 patients (23 males and 7 females with the age ranging between 29 and 51 years). Results: Our study confirmed this fact as preservation of lateral portion is suitable for planter flexion with gastrocnemius muscle and medial hemisoleus muscle flap showing long arc of rotation especially distally based posterior tibial artery medial hemisoleus muscle flap has long arc of rotation cover up to heal defect. Conclusion: Medial hemisoleus muscle flap is a reliable option for the reconstruction of soft tissue defects of lower leg based on minor pedicle or reversed flow based on posterior tibial artery. Careful flap dissection with preservation of as many perforators as possible is the key to success.

The Soleus Muscle Flap: An Overview of Its Clinical Applications for Lower Extremity Reconstruction.

Lower extremity reconstruction often poses several challenges for the reconstructive surgeon. Because of limited local tissue options, patients who sustain extensive middle to distal third tibia fractures used to be at higher risk of limb loss without adequate soft tissue coverage. The traditional principle of reconstructing middle and distal third leg wounds with free tissue transfer is being challenged by advances in understanding of local muscle flap anatomy and surgical techniques to improve the efficacy of local flaps. In this article, we examine contemporary considerations, developed by the authors, for the appropriate indications of free tissue transfer versus use of local flaps such as the soleus muscle flap. We review the versatility and reliability of the soleus muscle as a local muscle option once the technique is mastered on how to safely and effectively design and execute this flap. We highlight the importance of an algorithmic approach to soft-tissue reconstruction of the lower extremity based on the best surgical option for the patient. This includes factors such as medical history, appropriate surgical candidacy, as well as the size and mechanism of injury to decide the most viable option for lower extremity reconstruction. We show that the medial hemisoleus muscle flap is a reliable local option, both by itself or in conjunction with other local flaps, to reconstruct less extensive wounds in the middle to distal third of the leg. Ultimately, such a local muscle flap must be mastered by the reconstructive surgeon to augment his or her armamentarium to provide a well-rounded reconstructive plan in managing the soft-tissue wound, while minimizing donor-site morbidity and potentially be more cost-effective in nature.

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

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.

Distally Based Medial Hemisoleus Flap: Reliable Option for Distal Tibial Wounds.

To determine the success (flap survival as a whole without necrosis or dehiscence up to two months as judged clinically) of distally based medial hemisoleus muscle flap for the coverage of distal tibial defects. Case series. Jinnah Burn and Reconstructive Surgery Centre, AIMC, Lahore, from July 2014 to July 2017. Patients with middle and distal third tibial defects were enrolled and stratified according to the site of the wound in middle or distal third of tibia. Soft tissue coverage was provided with distally based medial hemisoleus muscle flap on which split thickness skin graft was applied. Postoperatively, patients were followed-up after one week of discharge and then fortnightly for at least 2 months. Outcome variable was taken as flap success. Out of 37 cases, flap was successful in 33 patients as complete flap survived with primary wound healing. Partial flap necrosis without dehiscence was seen in 3 cases and partial necrosis of flap with dehiscence in only one case that required another surgery for the defect. Complete flap loss was not seen in any case. Distally based medial hemisoleus muscle flap is reliable coverage option for middle and distal third of tibial defects.

Effect of medial hemisoleus muscle flap on wound healing in the medial and distal thirds of the lower leg

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: The role of local muscle flaps revisited

The proper soft-tissue management for an extensive mid-tibial wound of the leg with a less aggressive surgical approach has rarely been discussed in the literature and the reliability and the usefulness of such an approach to this challenging clinical problem remains uncertain. In this series, four patients with an extensive mid-tibial wound (12x3 to 22x6 cm) of the leg underwent the combined medial gastrocnemius and medial hemisoleus muscle flaps for soft-tissue reconstruction. Both muscle flaps were elevated with emphasis on the preservation of the critical perforators from the posterior tibial vessels to the medial hemisoleus muscle flap as possible and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles tendon to minimise functional loss. All patients except one had primary healing of their tibial wounds. One patient developed insignificant distal flap necrosis of the medial soleus flap and was treated with debridement and flap re-advancement. Three patients with tibial fracture also had evidenced healing of their tibial fractures. Limb salvage was achieved in all four patients during follow-up. Thus, the combined medial gastrocnemius and medial hemisoleus muscle flaps can be a valid option for soft-tissue coverage of an extensive mid-tibial wound of the leg when both local muscle flaps are not traumatised. Such an approach offers relatively simple but more cost-effective way to manage this complex clinical problem and should be revisited by reconstructive surgeons.

Further Experience with the Medial Hemisoleus Muscle Flap for Soft-Tissue Coverage of a Tibial Wound in the Distal Third of the Leg

Further Experience with the Medial Hemisoleus Muscle Flap for Soft-Tissue Coverage of a Tibial Wound in the Distal Third of the Leg

Soft-Tissue Reconstruction of an Open Tibial Wound in the Distal Third of the Leg

Over the past 4 years, a total of 33 patients, each with an open tibial wound in the distal third of the leg, underwent a skin-grafted muscle flap reconstruction according to the new treatment algorithm developed by the author. When the size of the soft-tissue defect was less than 50 cm, a pedicled medial hemisoleus muscle flap was used for the soft-tissue coverage (n = 20). If the soleus muscle was traumatized, a small free muscle flap (ie, gracilis) was then used (n = 3). When the size of the soft-tissue defect was greater than 50 cm, a larger free muscle flap (ie, rectus abdominis or latissimus dorsi) was selected (n = 10). All patients were followed for up to 4 years. Three patients with a medial hemisoleus muscle flap developed insignificant distal flap necrosis and were treated subsequently with debridement and flap advancement. Five patients with a free muscle flap required an additional operation, and 2 patients had a subsequent debulking procedure of the flap for contour improvement of the leg. Reliable soft-tissue coverage with a well-healed tibial wound, evident fracture healing, and good contour of the leg were achieved in all 33 patients during follow-up. Following this new treatment algorithm, a selected option for an open tibial wound in the distal third of the leg can provide reliable soft-tissue coverage for different sizes of open tibial wounds and may offer a more cost-effective approach for managing such a complex clinical problem.

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

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.

The Reversed Medial Hemisoleus Muscle Flap and Its Role in Reconstruction of an Open Tibial Wound in the Lower Third of the Leg

The usefulness of a reversed hemisoleus muscle flap as a local reconstructive option for soft-tissue coverage of an open tibial wound in the lower third of the leg has never been acknowledged. Over the past 2 years, 8 patients underwent soft-tissue reconstruction of an open tibial wound (3 x 3 to 10 x 6 cm) in the lower third of the leg with the reversed medial hemisoleus muscle flap modified by the author. The flap was dissected with attention to preserve several critical perforators from the posterior tibial vessels to the flap as possible while allowing adequate turnover of the flap to cover the exposed tibia or hardware. There was no total flap loss, and limb salvage was achieved in all patients. Only 2 patients developed insignificant distal flap necrosis, and they were treated subsequently with debridement and flap readvancement. All patients had reliable healing of their tibial wounds, with good reconstructive and cosmetic outcomes of their flap reconstructions during follow-up. Therefore, the author believes that the reversed medial hemisoleus muscle flap can be a good choice for soft-tissue coverage of a sizable open tibial wound in the lower third of the leg and may be used successfully to replace free tissue transfer in selected patients.

The Medial Hemisoleus Muscle Flap for Soft-Tissue Coverage of an Open Tibial Wound in the Distal Leg

The Medial Hemisoleus Muscle Flap for Soft-Tissue Coverage of an Open Tibial Wound in the Distal Leg

Successful Soft-Tissue Coverage of a Tibial Wound in the Distal Third of the Leg with a Medial Hemisoleus Muscle Flap

Successful Soft-Tissue Coverage of a Tibial Wound in the Distal Third of the Leg with a Medial Hemisoleus Muscle Flap