Soleus Perforator Flap

Abstract

The soleus perforator flap basically is a true perforator flap with a short pedicle, consisting of septo- or septomyocutaneous perforators on which anastomoses are performed. Thus, none of the main vessels of the lower leg has to be sacrificed. The perforators mostly arise from the peroneal vessels and are exposed at the proximal half of the lateral lower leg to allow for primary closure. Because of the similar anatomy of the skin paddle, the raising of this flap can easily be learned by surgeons familiar with the osteocutaneous fibular flap.

Before short pedicle perforator flaps such as the soleus perforator flap were established, free flaps from the lower leg were raised at the tibial posterior [449], tibial anterior [267, 415], and peroneal vessels [446], which served as the vascular pedicle. The tibial posterior flap was first described by Zhang et al. [449] as a distally based fasciocutaneous flap for defect cover at the foot and lower leg. In an anatomical study on 20 cadavers, the author found a high number of septocutaneous perforators coming from the tibial posterior artery. According to this study, three septocutaneous perforators from the posterior tibial artery can be found in the proximal, seven in the middle, and three in the distal lower leg.