Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: the role of local muscle flaps revisited.

The proper soft-tissue management for an extensive mid-tibial wound of the leg with a less aggressive surgical approach has rarely been discussed in the literature and the reliability and the usefulness of such an approach to this challenging clinical problem remains uncertain. In this series, four patients with an extensive mid-tibial wound (12x3 to 22x6 cm) of the leg underwent the combined medial gastrocnemius and medial hemisoleus muscle flaps for soft-tissue reconstruction. Both muscle flaps were elevated with emphasis on the preservation of the critical perforators from the posterior tibial vessels to the medial hemisoleus muscle flap as possible and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles tendon to minimise functional loss. All patients except one had primary healing of their tibial wounds. One patient developed insignificant distal flap necrosis of the medial soleus flap and was treated with debridement and flap re-advancement. Three patients with tibial fracture also had evidenced healing of their tibial fractures. Limb salvage was achieved in all four patients during follow-up. Thus, the combined medial gastrocnemius and medial hemisoleus muscle flaps can be a valid option for soft-tissue coverage of an extensive mid-tibial wound of the leg when both local muscle flaps are not traumatised. Such an approach offers relatively simple but more cost-effective way to manage this complex clinical problem and should be revisited by reconstructive surgeons. Copyright 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.