Muscle flaps and the vascular detour principle: the soleus

We present a concept in muscle and myocutaneous flap transfer whereby distally based flaps can, under very special circumstances, be transferred with an augmented arc of rotation and more reliable circulation. The concept is the inclusion of adjacent longitudinal vessels in the elevation, within which vessels the flow is reversed. To our knowledge this concept has not been previously described. The soleus muscle and eight other muscles have been found to be potentially useful in this regard. We report here our experience with 3 clinical cases of the distally-based soleus flap with a reversed pedicle, exemplifying the vascular detour principle. Our limited experience indicates no impairment of blood supply to the limb in short-term follow-up. Until further studies confirm the safety of major vessel sacrifice in a limb, we recommend only judicious use of this flap in highly selected situations.