- Discussion: - soleus is a bipiniform (double feather) shaped muscle; - its width encompasses the posterior two thirds of the calf; - it originates from the upper one third of the dorsum & medial surface of the fibula and mid-posterior tibia; - it inserts into the achilles tendon over a 5 cm area just anterior and distal to the insertion of the
Gastrocnemius muscle; - soleus muscle, when freed from its insertion on achilles tendon and based proximally, covers defects into the mid tibia; - because its most distal portion is narrow the coverage is smaller than one would like; - it has become flap of choice for middle, & some distal, tibial defects; - little function deficit occurs when hemi-soleous flap is raised; - blood supply can be unreliable, especially w/ tibial fractures; - soleus may be split into two independent segments, a maneuver that allows one hemisoleus muscle to be used as a flap and the other to be retained in situ for donor motor preservation; - this muscle may also be reversed on a distal blood supply to cover ankle defects, however, this may not be reliable;
- Contra-indications: - crushing tibial injury which disrupts blood supply to soleus;
- Flap Harvest: - skin incision proceeds from the medial aspect of tibial plateau to a point above the medial malleolus; - excise any small skin bridges that might be created; - dissection should begin at the midpoint of the flap, where the soleus is is easily separated from the more superficial
gastrocnemius; - subsequent separation of the deep surface of the soleus from
FDL is easily performed; - w/ a medial hemi-soleus flap, split the soleus longitudinally just lateral to the midline, to ensure that the intermuscular artery is not transected; - the posterior neurovascular bundle is identified; - the superficial and deep surfaces are cleared of soft tissue attachments;
- ligation of distal perforators: - for a proximally based soleus flap, distal perforators from posterior tibial artery are ligated and divided until the muscle can be transposed to cover the defect; - following ligation of the distal perforators, it is important to look for distal flap necrosis; - the distal muscle is relased from the Achilles, but a small portion of tendon should be left attached to the muscle;
