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Kondra et al. Plast Aesthet Res 2022;9:36 https://dx.doi.org/10.20517/2347-9264.2021.121 Page 5 of 9

Table 2. Injury & flap characteristics
n (%)
Mechanism of injury
Auto versus pedestrian (AVP) 34 (49.3%)
Motorcycle crash (MCC) 7 (10.1%)
Other 7 (10.1%)
Gunshot wound (GSW) 5 (7.2%)
Falls 5 (7.2%)
Auto versus stationary body 4 (5.9%)
Motor vehicle collision (MVC) 4 (5.9%)
Crush 2 (2.9%)
Soft tissue coverage
Middle 1/3 only 40 (58.8%)
Distal 1/3 only 15 (22.1%)
Middle 1/3 + distal 1/3 5 (7.4%)
Proximal 1/3 only 5 (7.4%)
Proximal 1/3 + middle 1/3 1 (1.5%)
Proximal 1/3 + distal 1/3 1 (1.5%)
Proximal 1/3 + middle 1/3 + distal 1/3 1 (1.5%)
Fractures
Fracture location (n=63)
Middle 1/3 of tibia 41 (65.1%)
Middle 1/3 of fibula 22 (34.9%)
Distal 1/3 of tibia 19 (30.2%)
Proximal 1/3 of fibula 15 (23.8%)
Distal 1/3 of fibula 10 (15.9%)
Proximal 1/3 of tibia 7 (11.0%)
Tibial plateau 3 (4.8%)
Calcaneus 2 (3.2%)
Gustilo-Anderson type (n = 56)
Type IIIB 35 (50.7%)
Type II 18 (26.1%)
Type IIIC 2 (2.9%)
Type I 1 (1.4%)

increased use of locally-based perforator flaps , there appears to be less reliance on the aforementioned
[12]
workhorse flap; however, it should not be overlooked as a reliable flap option for wounds involving the
middle-third leg, as demonstrated by 0% flap loss. The muscle bulk recruited during flap elevation is well
contoured for tibial coverage, providing added aesthetic benefit for these injuries. Additionally, the soleus
[5]
flap is a relatively simple and safe alternative to more complex microsurgical reconstruction with free flap
placement . Per operative dictation, indications for soleus flap placement were commonly weighed against
[12]
free flap placement; however, wound size, ability to approximate the defect, surrounding tissue quality, and
arc of rotation of the muscle belly prompted soleus flap selection. Reflective of the literature, soleus flaps
were mostly selected for wounds involving the middle- and distal-third leg.

The robust nature of the soleus flap is exemplified by 0% flap loss in our cohort, in which most patients
endorsed comorbidities unfavorable to a free flap, namely tobacco use. Our cohort demonstrated a higher
than expected incidence of overall infectious complications (17.6%); additionally, a significantly higher
percentage of smokers developed infectious complications (83.3%, P = 0.017), which is reflective of the