Proximal lateral leg flap transfer utilizing major nutrient vessels to the soleus muscle.

A new skin flap based on the cutaneous branches of the major nutrient vessel to the soleus muscle was designed and executed. An anatomic study of the major nutrient artery to the lateral half of the soleus muscle was performed on 26 legs. An angiographic study was performed on 27 legs. The major nutrient artery to the lateral half of the soleus muscle was classified according to its origin: the tibioperoneal trunk (type 1), the bifurcation of the posterior tibial and peroneal arteries (type 2), the posterior tibial artery (type 3), and the peroneal artery (type 4). The outer diameter of the major nutrient artery to the lateral half of the soleus muscle, by direct measurement, was 1.87 mm (range 1.1 to 2.5 mm). This new flap was applied in nine patients. The recipient sites were the great toe, the hand, the jaw, the anterior leg, the popliteal fossa, and the thigh. The vascular pedicle ranged from 6.5 to 9.5 cm in length. Tissue was transferred as a free flap in eight patients and as an island flap in one patient. All the flaps survived completely.