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Page 4 of 9 Kondra et al. Plast Aesthet Res 2022;9:36 https://dx.doi.org/10.20517/2347-9264.2021.121

Table 1. Patient demographics
n (%)
Total number of patients 68
Mean age (years) 39.4 ± 16.2
2
Average BMI (kg/m ) 27.8 ± 5.3
Obese (BMI > 30) 18 (26.1%)
Not obese (BMI < 30) 50 (72.5%)
Sex
Male 63 (92.6%)
Female 5 (7.4%)
Comorbidities
≥ 1 comorbidity 44 (64.7%)
Tobacco 36 (52.9%)
Illicit drug use 19 (27.9%)
Hypertension 17 (25.0%)
Diabetes mellitus 11 (16.2%)
Coronary artery disease 3 (4.4%)

BMI: Body mass index.

In certain cases, the soleus flap was combined with the medial gastrocnemius flap (n = 3), lateral
gastrocnemius flap (n = 1), vastus lateralis flap (n = 1), and anterolateral thigh flap (n = 1). Skin grafts were
employed in 67 patients (98.5%). Of note, eight patients (11.8%) suffered from arterial injuries.

Complications & long-term functional outcomes
Regarding postoperative complications, twelve patients (17.6%) suffered hardware infections (n = 2) and/or
osteomyelitis (n = 11) [Table 3]. Among these twelve patients, ten smoked tobacco, six endorsed illicit
substance use, four had hypertension, two had diabetes mellitus, and one had obstructive sleep apnea. One
patient with osteomyelitis required a below-the-knee amputation (BKA); notably, this patient suffered a GA
IIIB injury. Of these 12 patients, there were four concurrent upper extremity fractures and two concurrent
contralateral lower extremity fractures (n = 4). No statistical significance was found between high severity
fractures (GA type IIIA-C) and postoperative infection rate. Similarly, no significance was identified
between diabetes mellitus or > 1 comorbidity and infectious complications.

Six patients (8.8%) required flap revision and two (2.9%) experienced partial flap loss [Table 3]; notably, six
of these patients smoked tobacco. Three of the patients who needed flap revision developed osteomyelitis,
one of which also had a hardware infection. Of the eight patients who suffered arterial injuries, two required
flap revisions, and one necessitated an above-the-knee amputation (AKA); of note, the latter patient
suffered a GA IIIC injury. There was 100% flap survival at the most recent clinic follow-up.

The mean follow-up time from discharge date to latest follow-up with the PRS team was 3.7 months (SD:
6.8). Of the patients with documented follow-up, 35.3% of patients (n = 24) were independently ambulatory
after an average of 7.5 months (SD: 7.2) [Figure 1]. Twenty-four patients used a walking assistance device
(walker or cane) at the most recent follow-up, and twenty patients were wheelchair-dependent [Table 3].

DISCUSSION
An interesting trend identified in our review was 84% of soleus flaps were placed prior to 2016, with all
patients who received soleus flaps for isolated proximal-third leg injuries occurring prior to 2016. With the