Abstract
Purpose of the study: Osteitis with loss of distal soft tissue on the medial aspect of the leg raises a problem of cutanous cover, particularly in the event of longitudinal injury. Free flaps are frequently used with variable success in older patients with more risk factors. Four our more frail patients, we have used a retrograde soleus flap pediculated on the posterior tibial artery. We present here the possibilities offered by this flap and assess the different indications.
Material and methods: Six patients, mean age 55 years (range 44–68 years) were treated for cutaneous tissue loss measuring 9.5 x 6.5 cm on average. One patient was diabetic and two were smokers. The decision to use the soleus flap was made because of the presence of cutaneous lesions on the leg contraindicating a local falp. Arteriography revealed the persistence of the three vascular routes with satisfactory distal anastomoses, allowing high ligature of the posterior tibial arery intraopeartiely after a clamprepermeabilization test. The soleus flap was modeled to size and rotated en bloc with the tibial artery which was released to the retromaleolar localization for the distal flap^s. Treatment of osteitis incluced resection, cement filling and antibiotics then bone graft.
Results: All flaps survived. One had to be revised because of partial necrosis. There were no distal vascular problems. At minimum follow-up of 18 months, all the cases of osteitis had healed.
Discussion: The soleus flap pediculated on the posterior tibial artery is a reliable and effective flap. The territory covered can be very distal, reaching the foot. The vascularization of the soleus muscle allows moving the entire muscle, providing a very powerful flap. Deliberate sacrifice of a vascular supply considered as dominant for the leg is certainly a difficult decision, but which must be weighed against the risk of failure of a free flap.
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