Mid Term Results of the Medial Hemi Soleus Flap: A Retrospective Case Series

The lower one third of the leg, ankle, and posterior heel are devoid of robust soft tissue coverage. Coverage of exposed tendons, hardware, and bone can be challenging. The distally based medial hemi soleus flap is a viable option for soft tissue coverage.

The purpose of this retrospective study is to present a case series of medial hemi soleus flaps with midterm follow up. The medial hemi soleus flap is supplied by perforators from the posterior tibial artery. The arterial supply can be further improved by including the central raphe and thus the intermuscular artery. Complications of the flap are low, ranging around 8-20%; the most common complication is partial necrosis due to venous congestion.

Patients with co-morbidities are more prone to partial or complete flap loss and subsequent major amputation. We present a retrospective case series of five multi-comorbid patients that underwent treatment of osteomyelitis for posterior heel wounds or chronic ankle wounds due to Charcot deformity. Patients were treated with surgical debridement, culture driven parenteral antibiotics, deformity correction if applicable, and distally based medial hemi-soleus flap coverage of wounds. The distally based medial hemi soleus flap can cover defects of the distal third of the lower leg, ankle, and posterior heel. In contrast to free flaps, it allows for shorter operating time and does not necessitate microsurgical experience.

The flap has a relatively low complication rate in the literature, most of which are partial flap necrosis. In the setting of venous congestion and partial flap necrosis this can often be managed with various techniques to prevent total flap loss. At midterm follow up the medial hemi soleus is a reliable procedure for soft tissue coverage of the lower leg, ankle, and posterior heel.