The Reversed Flow Hemisoleus Propeller Muscle Flap

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Vascular Anatomy

Background:

• Soleus muscle flaps are adaptable for lower limb defect reconstruction, with variations including proximally based, distally based, island, or reversed flow.
• Previous literature described the soleus muscle as an island flap using a single distal perforator, but its use as a propeller flap rotated >90 degrees was not detailed.

Purpose of the Study:

• To meticulously investigate the vascular anatomy of the soleus muscle flap's distal perforators.
• To establish the utility of the soleus muscle flap as a propeller flap for lower extremity reconstruction.

Main Methods:

• A study involving 42 patients with diverse distal leg and foot defects.
• Preoperative assessment using Doppler and CT angiography to evaluate limb vascularity.
• The soleus muscle was elevated as a reversed flow flap, based on distal perforators and the posterior tibial artery, then rotated to cover defects.

Main Results:

• Complete flap survival was achieved in all cases, providing durable coverage.
• Limb vascularity remained unaffected in all patients post-reconstruction.
• No functional morbidity was observed at the donor site.

Conclusions:

• The reversed flow hemisoleus muscle flap, utilizing distal perforators and the posterior tibial artery, provides an extensive arc of rotation suitable for distal leg, ankle, and foot defects.
• This flap presents a valuable alternative to free flaps in lower extremity reconstruction.
• A new term, 'propeller hemisoleus muscle flap,' is proposed for this technique.