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The extended soleus muscle flap for selected distal third lower extremity soft tissue defects.
Nick Wolsefer, BS, Spencer Anderson MD, Thomas Johnson, Greg Gould BS, R. Michael Johnson MD, MPH
Wright State University
2018-01-29
Presenter: Spencer Anderson
Affidavit:
R. Michael Johnson MD MPH
Director Name: R. Michael Johnson MD MPH
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Free tissue transfer is not required for all soft tissue defects of the distal third of the lower extremity. Small defects may be covered with an extended soleus muscle flap. The purpose of this study is to measure the muscular reach and vascular supply of the soleus muscle to refine the reconstructive algorithm of the distal third of the lower extremity utilizing the extended soleus muscle flap.
Cadavers donated to the Wright State University Anatomic Gift program were obtained for examination of 22 lower extremities from 11 total cadavers, utilizing colored latex dye for identification of dominant pedicle and secondary perforators to the medial and lateral soleus muscle. The origin, location, number, and size of perforators were recorded. The muscle length in relationship to the medial malleolus was recorded.
A total of 11 cadavers, dissecting 22 distal lower extremities in 8 females and 3 males were assessed. The popliteal artery was identified as the most common origin of the dominant pedicle (10) supplying the soleus muscle, along with the posterior tibial artery (7), and the peroneal artery (5). The flap narrowed distally but this anatomic study demonstrated the approximate distal reach of the soleus muscle to be a 2 cm diameter soft tissue defect occurring 5 cm proximal to the medial malleolus.
Based on the present data, the proximally based soleus muscle flap can be a viable option for selected small distal third lower extremity defects. The senior author's clinical case series supports these findings
