Page 57 - Read Online

Kondra et al. Plast Aesthet Res 2022;9:36 Plastic and
DOI: 10.20517/2347-9264.2021.121
Aesthetic Research

Original Article Open Access

Soleus muscle flap for reconstruction of lower
extremity trauma. Workhorse or glue factory?

Katelyn Kondra, Christian Jimenez, Eloise Stanton, Idean Roohani, Jake Becerra, Joseph Carey

Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA 90033, USA.
Correspondence to: Dr. Joseph Carey, Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo
Street Suite 415A, Los Angeles, CA 90033, USA. E-mail: joseph.carey@med.usc.edu

How to cite this article: Kondra K, Jimenez C, Stanton E, Roohani I, Becerra J, Carey J. Soleus muscle flap for reconstruction of
lower extremity trauma. Workhorse or glue factory? Plast Aesthet Res 2022;9:36. https://dx.doi.org/10.20517/2347-
9264.2021.121

Received: 18 Nov 2021 First Decision: 21 Feb 2022 Revised: 8 Mar 2022 Accepted: 21 Mar 2022 Published: 17 May 2022

Academic Editors: Matthew L Iorio, Christopher S. Crowe Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Aim: Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower
extremity reconstruction and limb salvage. In the modern era, many surgeons prefer free flaps. This study sought to
evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1
trauma center.
Methods: This is an Institutional Review Board -approved, retrospective chart review that was undertaken at Los
Angeles County + University of Southern California Medical Center from 2007 to 2021. Patient demographics,
Gustilo-Anderson fracture classification, flap characteristics, and outcomes were collected and analyzed.
Outcomes of interest included failure rates, postoperative complications, and long-term ambulatory status.

Results: Of 187 local leg flaps, 68 (36.4%) were soleus flaps, with 84% of soleus flaps performed prior to 2016.
The flap loss rate was 0.0%. Eighteen (26.1%) flaps demonstrated > 1 complication, including
osteomyelitis/hardware infection (n = 12), flap revision (n = 6), and amputation (n = 2). Long-term follow-up
demonstrated 35.3% of patients ambulating independently after an average of 7.5 ± 7.2 months, with the
remainder needing a wheelchair or walking assistance device.

Conclusion: Although soleus flap loss rate was 0%, the findings demonstrate more infections than expected; this
must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement.
Additionally, our results reveal that only 16% of soleus flaps were performed after 2015. As surgeons consider the

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net