SLR - October 2019 - Rusheena Bartlett
Reference: Bortolini AC, Fraga DS. Soleus Muscle Flap Application for Reconstruction of the Middle Third of the Leg. International Journal of Orthoplastic Surgery. 2018;1(3):83–7. DOI: http://doi.org/10.29337/ijops.18Scientific Literature Review
Reviewed By: Rusheena Bartlett, DPM
Residency Program: Palmetto General Hospital – Hialeah, FL
Podiatric Relevance: Lower limb wounds are very prevalent and often present with various complications. These complications hinder wound healing and range from extensive soft tissue loss, poor vascular supply or underlying osteomyelitis. Soleus muscle flaps are an ideal treatment option for wounds in the middle third of the leg due to its large size, rich vascularity and simple technique. Podiatric surgeons can benefit greatly by using this technique to heal wounds in the lower leg whether it be due to trauma or infections. The soleus muscle flap has great versatility, a vast arch of rotation and can be placed directly over bone. It has also been shown to play a role in controlling infection by allowing antibiotics to reach the wound. One of the most beneficial features is the preservation of functionality due to the gastrocnemius muscle taking over plantarflexion once the soleus muscle is resected.
Methods: This is a retrospective case study which took place from 2015-2017. Seven (7) patients with wounds in the middle third of the leg were selected to receive soleus muscle flaps. Six out of the seven wounds were caused by trauma with bone exposure and one was caused from osteomyelitis. A medial incision approach was used for all patients, extending from the medial malleolus to the upper third of the tibia. The soleus was then dissected from the gastrocnemius and the Achilles tendon was separated. This technique allowed for a good arch of rotation to ensure the muscle flap would fully cover the defect. A partial skin graft was performed to avoid bleeding related graft loss. The patients were discharged from the hospital around day 20 and followed up as outpatients at one month, three months, six months and one year.
Results: Of the seven patients, there was one case of infection (14.3 percent). This patient was the only patient with diabetes mellitus, hypertension and underlying osteomyelitis. None of the patients required additional surgical intervention. All patients were noted to have a good outcome by achieving wound coverage with protection of deep structures.
Conclusions: The soleus muscle flap has rich vascularity from the tibial artery and its secondary pedicles, great versatility with a vast arch of rotation and is able to cover bone. It is also shown to have minimal functional sequelae, making it a desirable option for reconstruction of wounds in the middle third of the leg. This paper demonstrated a successful outcome in all patients. The information presented in this article poses a viable treatment option for lower extremity wounds with extensive damage and delayed healing.