• J Hankiss and C Schmitz.
• Klinik für Plastische, Ästhetische und Handchirurgie, Klinikum Lippe GmbH, Rintelner Str. 85, 32657, Lemgo, Deutschland. Janos.hankiss@klinikum-lippe.de
• Oper Orthop Traumatol. 2013 Apr 1;25(2):145-51.

ObjectiveDefect coverage especially in exposed bone of the lower leg by pedicled muscle flaps in association with a split-thickness skin graft. Defect coverage oropharyngeal or at the upper extremity by free soleus flaps.IndicationsDefects of the proximal and middle thirds of the anterior lower leg for the proximally pedicled soleus flap; defects of the middle and distal third of the anterior lower leg for the distally pedicled soleus flap. The free flap is almost ubiquitously useable.ContraindicationsPrimary diseases that makes a 2-h operation impossible, relevant affection of supplying vessels (the posterior tibial artery and/or the peroneal artery). Inadequate perfusion of the lower leg due to angiopathy, extensive soft-tissue infection, and wound contamination.Surgical TechniqueMedial, longitudinal incision, slightly posterior to the tibia, according to the desired flap elevation (distally or proximally pedicled). Preparation of relevant vessels, mobilization of the muscle and transposition into local defects or use as a free graft. The pedicled flaps usually need a split-thickness skin graft to cover.Postoperative ManagementClose monitoring of blood flow, temperature and swelling situation (hourly). Pressure-free wound-dressing of the leg, no circular or constricting dressings. Bedrest for 10 days, then start of flap training with intermittent circular compression, thrombosis prophylaxis, nicotine abstinence, physiotherapy, which depends on the bony situation, compression stocking after 3 weeks.ResultsReliable results achieved at the middle and distal lower leg.

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