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

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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 (12 x 3 to 22 x 6 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.

Original languageEnglish (US)
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume63
Issue number8
DOIs
StatePublished - Aug 2010

Fingerprint

Muscles
Wounds and Injuries
Leg
Tibial Fractures
Limb Salvage
Achilles Tendon
Debridement
Foot
Necrosis
Costs and Cost Analysis

Keywords

  • Flap
  • Gastrocnemius
  • Lower extremity
  • Reconstruction
  • Soleus
  • Tibial wound

ASJC Scopus subject areas

  • Surgery

Cite this

@article{8b5950810dea479f809b1ee2d5773d79,
title = "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",
abstract = "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 (12 x 3 to 22 x 6 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.",
keywords = "Flap, Gastrocnemius, Lower extremity, Reconstruction, Soleus, Tibial wound",
author = "Pu, {Lee Li-Qun}",
year = "2010",
month = "8",
doi = "10.1016/j.bjps.2010.05.003",
language = "English (US)",
volume = "63",
journal = "Journal of Plastic, Reconstructive and Aesthetic Surgery",
issn = "1748-6815",
publisher = "Churchill Livingstone",
number = "8",

}

TY - JOUR

T1 - Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps

T2 - The role of local muscle flaps revisited

AU - Pu, Lee Li-Qun

PY - 2010/8

Y1 - 2010/8

N2 - 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 (12 x 3 to 22 x 6 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.

AB - 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 (12 x 3 to 22 x 6 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.

KW - Flap

KW - Gastrocnemius

KW - Lower extremity

KW - Reconstruction

KW - Soleus

KW - Tibial wound

UR - http://www.scopus.com/inward/record.url?scp=77955510782&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955510782&partnerID=8YFLogxK

U2 - 10.1016/j.bjps.2010.05.003

DO - 10.1016/j.bjps.2010.05.003

M3 - Article

C2 - 20627760

AN - SCOPUS:77955510782

VL - 63

JO - Journal of Plastic, Reconstructive and Aesthetic Surgery

JF - Journal of Plastic, Reconstructive and Aesthetic Surgery

SN - 1748-6815

IS - 8

ER -