Background: Crushing injuries of the lower 1/3 of the
lower limb always represent a challenge for reconstruction.
Reconstructive options diminish with the injury of one or
more of the major vessels of the lower limb. This is a revisit
of distally based medial hemi-soleus muscle flap as a valuable
option in such reconstruction.
Patients and Methods: 16 patients with skin loss over
lower one third of leg of various causes had pre-operative
duplex done to detect affection of anterior tibial and/or peroneal
vessels and confirm patency of the posterior tibial vessels.
CT angiography was done for confirmation. In case of one or
two vessels affection, sparing the posterior tibial artery, the
defects in the distal one third of the leg were reconstructed
by distally based hemi-soleus muscle flap; based on the distal
perforators of the medial head of the soleus muscle from the
posterior tibial artery.
Results: The flap survived completely in twelve cases
with total loss in one patient, partial loss in two case and local
recurrence of the excised tumour in one case.
Conclusion: The distally based medial hemi-soleus muscle
flap is a very good option in reconstruction of problematic
lower one third skin defects especially that associated with
vascular injury other than the posterior tibial vessels.