Distally based medial hemisoleus flap: reliable option for distal tibial wounds

Objective: To determine the success [flap survival as a whole without necrosis or dehiscence up to two months as judged clinically] of distally based medial hemisoleus muscle flap for the coverage of distal tibial defects

Study Design: Case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, AIMC, Lahore, from July 2014 to July 2017

Methodology: Patients with middle and distal third tibial defects were enrolled and stratified according to the site of the wound in middle or distal third of tibia. Soft tissue coverage was provided with distally based medial hemisoleus muscle flap on which split thickness skin graft was applied. Postoperatively, patients were followed-up after one week of discharge and then fortnightly for at least 2 months. Outcome variable was taken as flap success

Results: Out of 37 cases, flap was successful in 33 patients as complete flap survived with primary wound healing. Partial flap necrosis without dehiscence was seen in 3 cases and partial necrosis of flap with dehiscence in only one case that required another surgery for the defect. Complete flap loss was not seen in any case

Conclusion: Distally based medial hemisoleus muscle flap is reliable coverage option for middle and distal third of tibial defects

Hemisoleus muscle flap, a better option for coverage of open fractures involving middle third of tibia

Local reconstructive options for middle third of leg make good use of Soleus muscle flap. Soleus being the prime ankle planter flexor and stabiliser of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. Due to this geometrical advantage, it is a superior option than the whole Soleus. We conducted a study to evaluate the reliability of the medial hemisoleus muscle flap for coverage of middle third tibial defects. This descriptive study was conducted at department of plastic surgery, Jinnah Hospital, Lahore from August 2008 to May 2009. Ten patients with middle third tibial defects were included in the study. All the patients were provided soft tissue coverage with proximally based medial hemisoleus muscle flap with split thickness skin graft on it. All the flaps survived with primary healing of the wound except one patient who developed wound infection which settled after wound drainage and irrigation. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of middle third of lower leg. It does not sacrifice the whole function of the Soleus muscle. Due to its longer arc of rotation, this flap can cover the defects of different size and shape in middle third of leg

Para-umbilical perforator based abdominal flap for forearm/hand resurfacing

A prospective study was carried out from October 1999 to December 2005 including 38 patients. The objective of the study has been to evaluate paraumblical perforator based abdominal flap for large forearm and hand defects. Prospective, interventional study. Methodology: 38 patients were evaluated for a period of six years and two months by filling a Performa which was entered in a database and different variables were evaluated. paraumblical perforator based abdominal flap is very useful for resurfacing large hand and forearm defects