Rotation Flap Research Articles

Wide resection and reconstruction of giant cell tumor of the distal humerus with favorable outcomes in 3 months: A case report

Introduction and importanceA giant cell tumor is a locally aggressive tumor with low-risk progression into malignant and rarely metastasize, but a high risk of recurrence and notable disturbance of bony architecture in peri-articular locations. Wide resection provides a more advantageous therapy option, but the functional outcome is often hampered.Case presentationA 36-years old woman came with a lump on the left elbow as chief of complaint since a year ago that kept growing bigger with pain, local tenderness, and limited motion. She underwent several examinations and was diagnosed with a giant cell tumor in the distal humerus. Wide excision and reconstruction surgery using megaprosthesis, rotational flap, nerve graft, and skin graft were done. After 3 months follow-up, the patient had favorable functional outcomes.Clinical discussionThe primary aim of treating giant cell tumors is wide resection with good functional than cosmesis outcomes. This manner was common and expected to reduce the potential risk of infection.ConclusionReconstruction with megaprosthesis, nerve and skin graft, is a reasonable option after wide resection of the giant cell tumor in the left humerus with favorable functional outcomes within 3 months compared with other treatment modalities.

Full-thickness lower eyelid defect reconstruction using a pedicle rotation temporal flap and Acellular Human Dermis Graft (Alloderm)

The aim of this research was to prospectively examine the combination of a pedicled temporal rotation flap with an acellular human dermal graft technique for intermediate-sized lower eyelid defect reconstruction. Pedicled temporal rotation flaps based on the orbicularis oculi muscle were used to reconstruct the anterior lamella of lower eyelid defects in six patients (five males and one female) while the posterior lamella was reconstructed using an acellular human dermis graft (Alloderm). Flap survival at 6 months was 100%. The functionality and cosmetic results of the technique were evaluated, and corneal protection was achieved. The texture and color of the reconstructed eyelid matched the surrounding skin, and neither pain nor corneal irritation was reported. The donor site scar healed well and was inconspicuous in all cases. Furthermore, no recurrence of malignancy was observed. The combination of a temporal rotational flap with an acellular human dermal graft is the key points. This technique could be ideal for the reconstruction of intermediate-sized full-thickness lower eyelid defects.

Rotational Occipital Scalp Flap for Occipital Pressure Ulcer.

Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa mass & ventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.

V01-06 OWN FLAP URETEROPLASTY-NEW SOLUTION FOR LONG STRICTURE

You have accessJournal of UrologyCME1 May 2022V01-06 OWN FLAP URETEROPLASTY-NEW SOLUTION FOR LONG STRICTURE Alexander Kheifets, Ben Valery Sionov, Masha Ben Zvi, and Alexander Tsivian Alexander KheifetsAlexander Kheifets More articles by this author , Ben Valery SionovBen Valery Sionov More articles by this author , Masha Ben ZviMasha Ben Zvi More articles by this author , and Alexander TsivianAlexander Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of long stricture in mid ureter is challenging and surgical options are scarce. In this video we present an alternative recourse where reconstruction of narrowed part of ureter is achieved using rotated flap taken from dilated proximal ureter. METHODS: 36 years old healthy woman investigated for recurrent right renal colic, the imaging revealed 3 cm stricture in right mid ureter with significant pre-stenotic dilation. Right kidney appeared obstructed according to DTPA scanning. The video demonstrates all the surgical steps of laparoscopic reconstruction. RESULTS: Operative time was 4.5 hours. Patient went home on second p/o day and the stent was removed 4 weeks following surgery. After more than 4 years of follow up there is no clinical, laboratory or radiographic evidence of recurrence. CONCLUSIONS: This technique may be a valid reconstructive option for mid ureteral long strictures in selected patients. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e53 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kheifets More articles by this author Ben Valery Sionov More articles by this author Masha Ben Zvi More articles by this author Alexander Tsivian More articles by this author Expand All Advertisement PDF DownloadLoading ...

Anesthesia Concerns and Management in Case of Severe Hemophilia A

Abstract Hemophilia is a genetic disease presenting with increased chances of perioperative bleeding. Preoperative recognition, assessment of risk, and careful titration of factor VIII transfusion are important for anesthesia management and decrease of morbidity. Here we present a case of severe hemophilia with an open wound of the knee scheduled for flap rotation and cover.

Comparison of Outcomes of Millard's Rotational Advancement Flap and Fisher's Techniques for Surgical Correction of UCLD

Objective: The objective of our study is to compare the surgical outcomes of two surgical techniques namely Fisher’s technique and Millard’s Rotational Advancement Flap, particularly in terms of white roll symmetry, lip length, lip height, scar quality, notching, cupids bow and alar base symmetry. Study design: Prospective Randomized Clinical Trial study. Place and duration of study: Department of Pediatric surgery, Sheikh Zayed Hospital, Rahim Yar Khan for a period of six months from 1st March 2021 to 31st August 2021. Patients and method: A total of 56 patients were enrolled in the study, equally divided into two groups. Group 1 will include patients undergoing treatment via Millard's Rotational Advancement Flap technique, while group 2 will include those receiving Fisher's procedure. A single consultant performed the procedure. Variables like lip length, Alar base symmetry, scar quality, cupids bow symmetry, and notching were accessed postoperative via the Steffensen grading method, and Vernier caliper was used for anthropometric measurements. The SPSS v 23 was used to evaluate the data. All numerical data were provided in mean and standard deviation (SD) formats. Frequencies were computed for qualitative data. Nonparametric tests (paired and unpaired t-tests) and parametric tests (Fisher's exact test) were utilized to compare the variables. P-value of < 0.05 was considered statistical significant. Results: Both groups had identical outcomes in terms of lip length, nasal symmetry, and alar dome. On the other hand, Fisher's approach was superior in terms of vermilion roll symmetry, white roll symmetry, scar appearance, and Cupid Bow. Anthropometric measures, such as lip height and breadth, were taken; however, the results were statistically insignificant. There was no discernible difference between the outcomes of complete and incomplete cleft lip. Conclusion: We propose using the Fisher's surgical method in unilateral cleft lip repair since it produces better outcomes than the Millard's procedure. Keywords: Anthropometric measurement; Fisher; Lip Notching; Millard; Scar; Unilateral cleft lip.

Experimental study of bed level changes in the vicinity of flap-type wave energy converters

ABSTRACT Details are given herein of the bed level changes in vicinity of the oscillating flap by means of physical modelling. Experiments were performed in a wave flume with a movable bed. Based on the results, changing the flap rotation angle (α) from a constant to an oscillating state caused less bed level changes (reduced range and length). Increasing the (h=water depth, L=wave length) decreases the range of bed level change profile and was effective on bed form. The (H=wave height) only affects the range of bed level changes profile in such a way that increasing this parameter first raise and then decreases the bed level changes. Intraction of above three parameters with the velocity components show that, by increasing the distance from the oscillating flap, more regular trend of velocity changes was observed. While complex behaviour was recognized in close distances to the structure.

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks.

BackgroundDecubitus ulcers are common skin injuries in plastic and burn surgery departments, usually occur in patients with a long disease course and poor underlying health. Designing a reconstruction procedure with safety blood supply to a large volume soft tissue and resulting in minimal trauma is a priority for surgeons.MethodsThe free-style perforators on the potential donor sites surrounding the ulcers were detected by Doppler, and the area of the ulcer was divided into several sections based on the location of pre-design perforator flaps. According to the insertion point of the perforators, small V-Y advancement flaps, propeller flaps and rotation flaps pedicled with freestyle perforators were formed and moderately modified during surgery. All of the small flaps were transplanted from donor sites to the defect and reassembled into a new composite flap to repair the ulcer. The donor sites were directly closed. The area of the flaps ranged from 7.0 × 10.5 cm to 8.0 × 22.0 cm and the diameter of the pedicle perforators ranged from 0.5 to 4.0 mm.ResultsIn 30 patients, 65 flaps were constructed, and all of the flaps survived with direct closure of all donor sites. One case with effusion healed 1 month postoperatively through draining and application of a mild pressure dressing. After a 3–24 months follow-up period, all of the patients were satisfied with post-operative function and appearance, and only one case had a local recurrence 6 months postoperatively.ConclusionThe jigsaw puzzle flap based on freestyle perforators can repair the large skin and soft tissue defects caused by decubitus ulcers on the buttocks, with direct donor flap area closure. This method is easy to perform with a safe blood supply and minimal trauma resulting from the avoidance of microvascular anastomosis and the conventional myocutaneous flap.

Different surgical procedures for reconstruction of soft-tissue defects around the ankle

IntroductionManagement of soft tissue defects around the ankle is a difficult and challenging situation for all reconstructive surgeons. A microsurgical free flaps coverage can solve this problematic situation especially with large defects that is not available in all trauma centers. Moreover, long operating time and suitable operative demands are considered obstacles. Materials and methodEighty five patients having soft tissue defects around ankle were included in this study. They underwent various reconstructions in our specialized hand and reconstructive microsurgery unit from 2015 to 2019. Fifty two were males and thirty three patients were females. Road traffic accident was the main cause of injury in 66 patients followed by implant exposure in 15 patients and chronic osteomyelitis in 4 patients. Distally based superficial sural artery flap was used to reconstruct the defects in 21 cases, free flap was used in 32 cases, Rotational local flap was used in 8 cases, contralateral distally based superficial sural artery flap was used in 2 cases, full or partial skin flaps were used in 10 cases and Propeller flap was used in 12cases. ResultsAll flaps survived except for one modified sural flap with 98% success rate and average follow up of 48 months. All patients were satisfied with the functional capacity of operated limbs. Average time of bone healing postoperative was 3 months with gradual return to original work with acceptable degrees for cosmotic appearance of the limbs. ConclusionMany treatment options are available to cover defects around the ankle. Propeller and rotational flaps are fast and easy but cover small defects, distally-based modified sural artery flap is an excellent reliable flap. Microsurgical free flaps provide good contour, color, texture and cover large defects but require microsurgery facilities to execute.

A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy

BackgroundTracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. MethodsOur study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. ResultsWe identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. ConclusionOur multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.

“THUNDER – LIKE” PLASTY FOR TWIN NASAL TIP DEFECTS. TECHNIQUE DESCRIPTION AND INDICATIONS

​INTRODUCTION: Reconstructive approaches to nasal tip defects are always challenging to perform, depending on the age of the patient, shape of the nose, local anatomy and adjacent structures. Many techniques have been described, each one with its advantages and limitations. AIM: Our aim is a new technique description designed for the reconstruction of twin defects of the nasal tip. The decision-making, the step-by-step description, and its application to a male patient are explained in detail. MATERIAL - METHOD: A 61 years old male patient was referred to our department with two benign lesions of the nasal tip. Due to their proximity, a simultaneous excision was planned in a way that allowed both adequate excision and minor defect dimensions. The remaining defect was reconstructed with a combination of 2 rotation flaps and 2 V-Y plasties. RESULTS: Very good skin match (color and texture). Suture lines are barely detectable because they are buried in the anatomical border between the nasal tip and the alar area. No consequences for the alar shape or the columella are mentioned (deviation, stricture, narrowing or flattening respectively). CONCLUSION: This technique has been influenced by the “East – West plasty”. Its innovative elements are: 1. The upper triangle hereafter contains the second lesion. 2. The V-Y plasties we intendedly added on top of each rotation flap limit loss of length resulting in well aligned scars. The technique is advisable for benign lesions, in situ malignancies or for centers performing Mohs micrographic surgery.

Comparison of Pterygium Recurrence with and Without Using Postsurgical Topical Cyclosporin a 0.05%

Purpose:To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery.Methods:In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared.Results:The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99).Conclusion:The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

Modern Developments in Catalysis, Volume 2

A new construction of the pulsator for generating sinusoidal pulsating flows of a continuous medium in the channels of experimental setups have been performed. The pulsator is based on operating experience of existing types of latter used for the frequency range 0.03 < f < 0.8 Hz and is differed from them due to the use of a profiled flap. The flow structure using the pulsator is studied based on the theoretical analysis and experimental verification via the hot-wire anemometry and SIV method. It is shown that the profiled flap allows more than an order increase in the frequency of the flap rotation f ˜ 25 Hz, which maintains an almost sinusoidal law of flow rate. A criterion for estimating the efficiency of pulsator has been presented and an analytical expression has been obtained for estimating the impact of inertial forces on the law of variation of average velocity over the phase angle. The deviation from the harmonic law realized by the submitted pulsator at f = 25 Hz is 3 times smaller than the deviation characteristic for a pulsator with a ball flap and 6 times smaller for one with a butterfly flap at f = 0.04 Hz.

The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site.

BackgroundThe radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site.MethodA cohort study of six patients (five male, one female; mean age 59 [range 19–90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra‐flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap.ResultsIn all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6–15 cm (mean 11.5 cm) and widths of 4–6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24–90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow‐up of 6 months (4–24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15.ConclusionThe modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.

The Twizzler: a modified primary closure for distal lower extremity wound reconstruction utilizing a dynamic winch stitch.

Management of lower extremity wounds following successful tumor excision presents multiple challenges. Distal lower extremity integument is highly prone to edema often lacks adequate skin laxity for standard primary closures. The closure must be resilient enough to withstand mobility. As a result, optimal reconstruction may include skin grafting, rotational flaps, free tissue transfers, healing by second intention, or some combination. These methods may involve multiple steps in reconstruction, a prolonged recovery period, increased cost, and higher infection risk. We propose a modified primary closure that takes advantage of the visco-elastic properties of the skin without introducing additional components or steps. This technique is initiated with percutaneous suture in order to intermittently stretch the skin with constant tension. This load cycling allows for lower extremity skin to stretch over time and ultimately reduce wound edge tension, allowing for ease of absorbable suture placement. The Twizzler technique is cost-effective, uses readily available supplies, and effectively closes relatively large defects on the lower extremities.

Reconstruction of cutaneous dorsal finger defects.

Reconstruction of surgical defects on the dorsal finger can be challenging because of a lack of adjacent tissue reservoirs, poor laxity, and often thin, atrophic skin surrounding the defect. To present reconstructive options for cutaneous dorsal finger defects. We describe our five preferred approaches to reconstructing cutaneous dorsal finger defects based on the amount of available underlying tissue and location of the defect on the finger. In the authors' opinion, for smaller defects between and including the metacarpophalangeal joint extending to the proximal interphalangeal joint, a transposition flap or unilateral advancement flap is preferable. For proximal finger defects that are wider, a unilateral rotation flap is appropriate. A Burow full-thickness skin graft can be used for any proximal defect with underlying soft tissue present. For defects with underlying bone or tendon present, a reverse cross-finger interpolation flap can be utilized. The unilateral advancement flap, unilateral rotation flap, transposition flap, full-thickness skin grafts, or the reverse cross-finger interpolation flap can be used to reconstruct the majority of cutaneous dorsal finger defects.

Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland

Treatment for facial nerve-invading parotid malignancies usually results in complete facial palsy. The authors present a novel technique to treat facial palsy following radical parotid surgery and retrospectively evaluate results in terms of soft tissue symmetry at rest and during smiling and eyelid closure using the eFACE system.9 patients with facial palsy following parotid malignancies resection or undergoing parotidectomy with planned facial nerve resection for tumor invasion were treated with the association of mini-invasive temporalis flap rotation and upper lid lipofilling to restore symmetry of the middle facial third at rest and during smiling and eyelid closure. The technique was employed during the same surgical session as the tumor removal or for secondary facial reanimation.Systematic eFACE evaluation demonstrated significant improvement in static nasolabial fold depth orientation and oral commissure position, palpebral fissure narrowing during eye closure, and oral commissure movement and nasolabial fold depth and orientation with smile (p respectively .008, .011, 0.008, 0.035, 0.011, 0.008, and 0.011, Wilcoxon's test). Furthermore, all patients described subjective improvement of corneal discomfort.The presented technique appears promising in treating facial palsy in oncological patients, representing a potential alternative to other more complex reconstructive techniques.

Acute Forearm Compartment Syndrome Postdialysis

Postdialysis compartment syndrome is a rare but very devastating condition which needs emergent diagnosis and treatment. This can happen due to bleeding from puncture site due to inadequately applied pressure/coagulopathy. This case report illustrates a case of postdialysis pseudoaneurysm formation followed by forearm compartment syndrome. The patient was managed by emergency forearm fasciotomy and skin grafting along with rotation flap. This diagnosis should always be kept in mind when evaluating a patient with sudden onset of pain and swelling postdialysis. This will help in salvage of the patient's upper limb as well as of the precious arteriovenous fistula.

Assessment of Flap Viability for Complex Transmetatarsal Amputation Using Indocyanine Green Fluorescent Angiography: A Case Study.

Despite advancements in the treatment of diabetic patients with "at-risk" limbs, minor and major amputations remain commonplace. The diabetic population is especially prone to surgical complications from lower extremity amputation because of comorbidities such as renal disease, hypertension, hyperlipidemia, microvascular and macrovascular disease, and peripheral neuropathy. Complication occurrence may result in increases in hospital stay duration, unplanned readmission rate, mortality rate, number of operations, and incidence of infection. Skin flap necrosis and wound healing delay secondary to inadequate perfusion of soft tissues continues to result in significant morbidity, mortality, and cost to individuals and the health-care system. Intraoperative indocyanine green fluorescent angiography for the assessment of tissue perfusion may be used to assess tissue perfusion in this patient population to minimize complications associated with amputations. This technology provides real-time functional assessment of the macrovascular and microvascular systems in addition to arterial and venous flow to and from the flap soft tissues. This case study explores the use of indocyanine green fluorescent angiography for the treatment of a diabetic patient with a large dorsal and plantar soft-tissue deficit and need for transmetatarsal amputation with nontraditional rotational flap coverage. The authors theorize that the use of indocyanine green may decrease postoperative complications and cost to the health-care system through fewer readmissions and fewer procedures.

Short and long-term follow-up results of soleus muscle rotation flap for coverage of soft tissue defects of proximal and middle leg

Objective: &#x0D; To observe the short and long-term outcomes of the soleus muscle rotation flap for coverage of soft tissue defects of proximal and middle leg.&#x0D; Study Design:&#x0D; Case series&#x0D; Place and duration of study&#x0D; Departments of Plastic and Reconstructive Surgery of Bahawal Victoria Hospital Bahawalpur, Combined Military Hospital Bahawalpur, and Combined Military Hospital Quetta from December 2014 to February 2020..&#x0D; Materials and methods&#x0D; In total, 36 patients were enrolled for the study through consecutive sampling. Data was processed using SPSS-17. All patients were reviewed at first and second week (early morbidity), and then at six months (late morbidity) from operation. During early follow up, they were examined for hematoma at donor site, wound infection, sural nerve injury, graft loss, and flap necrosis. In late follow-up, patients were examined for reduced knee mobility, muscle weakness, sensory abnormalities, hypertrophic scarring, hyperkeratosis, and soleus muscle contractures.&#x0D; Results &#x0D; The studied patients consisted of 30 (90.9%) men and 3 (0.9%) women. The mean age was 35 years (range: 16 to 64) years. Hematoma was the commonest complication. It occurred in 6.1%. Wound infection, partial loss of flap, partial loss of skin graft and wound infection occurred in 3.03% patients. Late follow up revealed reduced knee mobility in 9.09% patients (n=3) and bothersome contraction of soleus muscle in same number of patients.&#x0D; Conclusion&#x0D; The soleus flap is reliable, versatile, and very useful for provision of supple soft tissue coverage for defects in upper and middle leg.