Distally based medial hemisoleus muscle flap for reconstruction of distal and middle third leg defects.

Abstract

Objective: To prospectively assess the clinical efficacy, flap survival, functional, and donor-site morbidity of the distally based medial hemisoleus muscle flap in reconstruction of soft tissue defects located in the distal and middle thirds of the lower leg. Study Design: Prospective Cohort study. Setting: Department of Plastic and Reconstructive Surgery, Bakhtawar Amin Medical and Dental College, Multan. Period: January 2024 to December 2025. Methods: The reconstruction was done in forty-two adult patients with traumatic, post-oncological, or post-infectious defects (4-10 cm) in the distal or middle leg. Vascular mapping before surgery, standardized surgical practice and standardized postoperative practices were adopted. Outcomes were determined as primary flap survival, complication rates, Lower Extremity Functional Scale (LEFS) scores, ankle range of motion (ROM), donor-site morbidity and patient-reported aesthetic satisfaction. Descriptive statistics, chi-square/Fisher exact tests, paired t-tests, and multivariate logistic regression (alpha=0.05) were performed using statistical analysis. Results: The survival rate of complete flaps was 40/42 (95.2). Significant complications were experienced in 4 patients (9.5%), of which 2 experienced a partial distal necrosis, 1 experienced a superficial infection and 1 experienced a wound dehiscence. Free tissue transfer did not need any flap loss. Mean LEFS improved from 38.2±6.1 preoperatively to 72.4±5.8 at 12 months (p<0.001). Multivariate analysis showed that the size of defects greater than 8 cm and active smoking were independent predictors of minor complications (p=0.012 and p=0.028, respectively). Conclusion: The medial hemisoleus flap, which is distally based and of a medial location, is a reliable and single-stage, functional preserving reconstructive option in distal and middle third leg defects. It provides high rates of survival, low rates of donor-site morbidity, and good functional recovery as a useful alternative to free flaps and traditional local flaps in suitably selected patients.