Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects
Elwakeel, H. (2021). Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects. EKB Journal Management System, 45(4), 211-218. doi: 10.21608/ejprs.2021.201630
Helmy Elwakeel. "Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects". EKB Journal Management System, 45, 4, 2021, 211-218. doi: 10.21608/ejprs.2021.201630
Elwakeel, H. (2021). 'Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects', EKB Journal Management System, 45(4), pp. 211-218. doi: 10.21608/ejprs.2021.201630
Elwakeel, H. Distally Based Medial Hemisoleus Muscle Flap for Reconstruction of Distal and Middle Third Leg Defects. EKB Journal Management System, 2021; 45(4): 211-218. doi: 10.21608/ejprs.2021.201630

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

The Egyptian Journal of Plastic and Reconstructive Surgery
Article 3, Volume 45, Issue 4, October 2021, Page 211-218  XML PDF (20.26 MB)
Document Type: Original Article
DOI: 10.21608/ejprs.2021.201630
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Author
Helmy Elwakeel email
The Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt
Abstract
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 < br />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 satisfactory
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 partialthickness
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.
Keywords
Medial hemisoleus flap; Distal leg defects; Distally based flap
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