Purpose of the study: Covering cutaneous tissue loss of the distal quarter of the leg and ankle remains a difficult surgical challenge. We report our experience with a new lateral hemisoleus island flap with a fibular pedicle specifically adapted for large-sized defects.

Material and method: Preliminary anatomic work on 15 injected legs demonstrated that:

the dimensions of the muscular part of the lateral head of the soleus measures on average 218 mm (range 160–270) in length and 73 mm (range 58–95) in width, sufficient for large “tailored” flaps;

a main pedicle arises constantly from the fibular artery to supply the lateral hemi-soleus in addition to, on average, three secondary pedicles;

the distal pivot point, corresponding to the branch perforating the fibular enables not only cover for the ankle, but also the foot reaching the metatarsal heads.

Results: Three patients treated with success are presented. The advantages of the technique are large muscle volume, safe vascular supply and significant mobility. Drawbacks include sacrifice of the fibular artery and difficult dissection of the fibular pedicle. Preoperative precautions are indispensable: arteriography, exclusion of contusion cases affecting the muscle masses or compartment syndrome.

Discussion: The lateral hemi-soleus flap can be a useful therapeutic option for major tissue loss on the distal quarter of the leg, the ankle, or even the foot. It is an attractive alternative to free flaps, the only other solution for large defects.