Medial Hemisoleus Research Articles

Successful four flap reconstruction for extensive crush injuries of bilateral lower limbs using local pedicled flaps in a 73-year-old patient: a rare case report

Extensive soft tissue defects with periosteal stripping over critical areas of tibia pose a tough challenge to the reconstructive plastic surgeon. Treatment of choice for these defects is free tissue transfer. Local pedicled fasciocutaneous or muscle flaps are used only when the free tissue transfer is not possible. The gastrocnemius and soleus flaps either used as a combined flap or as individual separate flaps can be an alternate reconstructive option for these defects in selected cases. Here we report a 73-year-old male patient a case of extensive crush injury involving both lower limbs following a motor vehicle accident (MVA) in whom we have successfully reconstructed the extensive soft tissue defects with exposed tibia with four local pedicled flaps. The purpose of writing this case report is that when free tissue transfer is not possible in such extensive crush injuries, a durable functionally and cosmetically acceptable reconstruction with pedicled hemi gastrocnemius and medial hemisoleus flaps can be done after a meticulous planning and flap design without any significant functional donor site morbidity.

Efficacy and Versatility of the Medial Hemisoleus Flap for Complex Middle Third Tibial Defects: A Presentation of 2 Cases

Soft tissue injuries involving the middle third of the tibia can present significant clinical challenges, often leading to complications such as infection and nonunion. This article explores the efficacy of the medial hemisoleus flap as a valuable surgical technique for addressing these complex wounds. Two case reports are presented to illustrate the successful use of this flap in clinical practice. The medial hemisoleus flap offers consistent blood supply, improved arc of rotation, and reduced donor site morbidity, making it an excellent choice for reconstructive surgery in this anatomical region. In the first case, a 17-year-old patient with a history of smoking developed an open fracture in his left leg two years after a car accident, which led to a soft tissue defect with exposed bone in the middle third of his left leg. In the second case, a 25-year-old male involved in a traffic accident presented with a displaced open bone fracture of the middle third of the tibia and fibula with bone sequestrum. Surgical technique, advantages, patient selection criteria, and outcomes are discussed, highlighting the significance of the medial hemisoleus flap in addressing these challenging wounds.

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.

Soleus Muscle Flap for Coverage of Soft Tissue Defect of Leg

Background: Open tibia fracture with soft tissue loss at the fracture site is and always a challenging problem for orthopedic surgeons to deal with. Soleus flap is an important option for such defects out of many other options. Methods: Retrospective descriptive study in which twenty-one patients with open tibia fracture with soft tissue defect at fracture site requiring flap coverage were included in the study. In all 21 patients, the soleus muscle flap was done. Results: Out of 21 patients, in 16 patients medial hemisoleus flap was done and in five composite soleus muscle flap was done. The average age of the patients was 37.8 years, and the right leg was more involved. In all patients, bone coverage was achieved. Three patients required debridement and mobilization of flap due to infective necrosis at the margin. The mean follow-up was 12 months. Conclusion: Soleus muscle flap is a good and versatile flap for the coverage of soft tissue defects of the leg exposing bone or fracture.

Medial Hemisoleus Flap for Middle Third of the Tibia Defects

The anteromedial portion of the tibia lacks significant soft tissue coverage and is susceptible to open wounds which are most often of traumatic origin. In such cases, bone exposure and subsequent infection represent the most dreaded complications [1]. In order to prevent this, the soleus muscle flap, first described by Tobin in 1985, has proved to be an excellent treatment option

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.

Outcome of Soft Tissue Coverage in Open Tibia Fractures with Non-Microvascular Flap at a Tertiary Care Hospital

Background: Open tibia fractures are high energy injuries often associated with large soft defects, extensive soft tissue stripping and contamination requiring multiple debridement procedures. Collective ortho-plastic approach helps us achieve proper debridement, adequate fixation and early soft tissue coverage. Due to fairly high incidence of failure, steep learning curve, time consuming procedure and the cost of treatment for those tedious free flaps, non-microvascular flaps are being preferred to cover the soft tissue defects or exposed hardware in open tibia fractures.
 Materials and Methods: A prospective study was carried out in 19 patients to assess the outcome of soft tissue coverage in open tibia fractures with non-microvascular flap. Out of these patients, 6 patients were treated with medial gastrocnemius flap, 5 patients with medial hemi-soleus, 5 patients with reverse sural fasciocutaneous flap, and 3 patients with local rotational random flaps. Outcome measures included bony union, deep surgical infection and flap failure.
 Results: 84% patients were male whereas 16% patients were female. Road traffic accident was the major cause of the defect among the patients (74%). Complications in the form of deep infection (10%), non-union (21%), delayed union (10%) and marginal flap necrosis (21%) were observed.
 Conclusion: In our study, early soft tissue coverage with appropriate non-microvascular flaps in management of severe open fractures of tibia was associated with more favourable outcomes.

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.

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.

Functional Outcome After Reconstruction of Traumatic Soft Tissue Defects in the Lower Half of the Leg With Distally Based Medial Hemisoleus Muscle Flaps: A Case Series and Literature Review.

Data regarding donor-site morbidity, postoperative clinical course, and functional outcome after hemisoleus muscle flap reconstruction are rare. The aim of this study was to determine the clinical and functional outcome of distally based medial hemisoleus flaps used for the reconstruction of defects in the lower half of the leg. Data regarding 31 patients who underwent medial hemisoleus flap reconstruction between 2011 and 2017 were analyzed retrospectively. Epidemiological data and data on clinical outcomes and complications were obtained from hospital records. Functional outcome data were recorded in 14 cases. All soft tissue defects were secondary to trauma; 90.3% were male and 9.7% were female. Mean age was 52 years (range, 16-77 years). Mean defect size was 48 ± 9.5 cm. Flap survival was complete in 29 patients and partial in 2 patients. The maximal plantar flexion force in the ankle joint of the operated leg was 78.1% (P < 0.05) compared with the unaffected side. Strength endurance was reduced by 16.5% (P < 0.05) in the operated leg compared with the unaffected side. Medial hemisoleus flaps should be included in the armamentarium for reconstruction of small to middle traumatic lower leg defects. They are quick to raise and inset and provide robust coverage. Although there is an objective reduction in plantar flexion and endurance, this did not translate into functional limitations in our group of patients. To our knowledge, this represents the largest case series to date of functional outcome of distally based medial hemisoleus flap reconstruction in lower limbs.

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.

A Retrospective Look at Integrating a Novel Regenerative Medicine Approach in Plastic Limb Reconstruction

Full-thickness wounds that have rendered patients candidates for amputation may require techniques that may include a combinatorial approach above traditional standard of care. The purpose of this retrospective study was to evaluate the effectiveness of an innovative approach whereby several therapies were combined to avoid amputation. Patients with full-thickness wounds who were previously recommended for amputation and were treated with the combinatorial approach of muscle flap reconstruction and concentrated bone marrow aspirate, platelet-rich plasma, INTEGRA Wound matrix, vacuum-assisted closure, and split-thickness skin grafts were assessed retrospectively. The mean age of the patients identified was 48 years (range, 34–66 years). The average size of the defects was 19.6 cm2. All defects were successfully covered with medial hemisoleus, lateral hemisoleus, or peroneus brevis muscle flaps combined with split-thickness skin grafts, concentrated bone marrow aspirate, and platelet-rich plasma. All flaps healed with an average time to fixator removal of 8.3 weeks; there was 1 above-knee amputation that occurred approximately after successful wound closing and fixator removal. The combinatorial approach described here including several regenerative medicine tools is an effective means of lower limb reconstruction to avoid amputation.

Reverse Medial Hemisoleus Flaps for Coverage of Distal Third Leg Wounds: A Technical Trick.

Traditionally, free tissue transfer has been used to cover wounds of the distal third of the leg. Advances in flap anatomy, elevation, and surgical techniques have allowed the use of pedicled flaps to avoid the use of free tissue transfer in certain situations. The authors describe a technique for using a reversed medial hemisoleus flap to provide soft tissue coverage for wounds of the medial distal leg. In the senior authors experience, the use of this flap has achieved wound coverage in 100% of patients with smaller wounds (≤50 cm) of the medial leg.

Reconstruction of the Soft Tissue Defect on Anteromedial Surface of the Leg Using Medial Hemisoleus Flap

Reconstruction of the Soft Tissue Defect on Anteromedial Surface of the Leg Using Medial Hemisoleus Flap