Multiple, synchronous ipsilateral soleus muscle flaps, including the Achilles' "wraparound" flap.

Abstract

Versatility of the soleus muscle beyond its traditional role for the middle third of the leg is often overlooked. Substantial muscle bulk frequently extends even to the calcaneus, although this is quite variable. Its distal reach as a muscle flap then may potentially include encircling the Achilles' tendon itself as a local "wraparound" flap in an area otherwise notorious for requiring the complexity of a free tissue transfer. Since this maneuver only envelops the Achilles' tendon by stretching its own inserting soleus muscle, no muscle dissection per se is required, and nutrition from minor pedicles is sustained. Therefore, concomitant proximally based hemisoleus flaps can be utilized simultaneously and safely for more conventional coverage of midtibial defects. In this fashion, multiple, independent local flaps from a single soleus muscle can achieve coverage of disparate leg wounds, while sacrificing a minimum of donor site function.