Sliding soleus flap - A useful flap in primary management of compound wounds of leg

Background: Lower leg trauma with compound wounds of leg with need for wound cover are common injuries encountered by plastic surgeons. Soleus flap is an extremely useful flap in acute management of compound fractures of lower leg especially middle and lower third. However, the soleus being in zone of trauma in such defects, reconstructive surgeons hesitate to use it primarily. This article proposes a novel way of using the soleus muscle by sliding it across the defect and not transecting its lower end as traditionally done. Although many of these wounds can be managed secondarily, addressing the wound primarily with the exposed soleus helps reduces need for more complex reconstructive surgery at a later surgical sitting.

Aims and objectives: The aim of this study is to assess the usefulness of the sliding soleus flap in covering compound wounds of middle and lower third of leg.

Material and methods: The study was conducted during the period between April 2010 to April 2015. The sliding soleus was used to cover 25 cases of lower leg trauma with middle and lower leg defects up to 10 cm above ankle joint.

Results: All the flaps survived though in some cases superficial necrosis was encountered. In these cases, the necrosis was debrided during dressings and did not require any operation theater intervention.

Conclusion: In the acute trauma scenario where the plastic surgeon is called upon to address compound fractures of tibia and fibula, it is recommended to close the exposed bone with sliding soleus flap. Here the soleus muscle is slided into defect without transection. The sliding soleus flap has three advantages. One it has vascularity of both dominant and minor vascular pedicle and is more reliable compared to either a proximal or reversed soleus flaps. The second advantage is that there is no functional deficit as the muscle is only transposed and not disconnected. Thirdly the reach of the soleus muscle for coverage of upper lower third leg defects can be achieved.