Soleus Flap for Lower Leg Reconstruction

Open wounds in the middle third of the lower leg often require soft tissue reconstruction to allow for primary wound healing. The soleus muscle flap is uniquely suited for this purpose and is used primarily as a muscle flap without the accompanying overlying skin. This muscle has a blood supply that is segmental in nature, arising from multiple perforators from the posterior tibial vessels. Given that that this blood supply is primarily located in the proximal third of the leg, the soleus muscle flap is generally based proximally to allow for coverage of middle-third defects. While the muscle has a clear intermuscular septum which separates the medial head from the lateral segment, the use of a so-called hemi-soleus flap is less reliable and thus used on an infrequent basis. The soleus muscle flap can also be based distally in the leg for small distal-third defects; however, this flap can often be unreliable due to a paucity of sufficient perforators located in this area.