Download PDF
J Reconstr Microsurg 2021; 37(01): 089-096
DOI: 10.1055/s-0040-1709480
Original Article

The Essential Local Muscle Flaps for Lower Extremity Reconstruction

Andrew Atia 
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Rebecca Vernon
2   Department of Surgery, Duke University School of Medicine, Durham, North Carolina
,
Bryan J. Pyfer
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Ronnie L. Shammas
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
,
Scott T. Hollenbeck
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Lower extremity reconstruction is often a challenging prospect with major implications on a patient’s quality of life. For complex defects of the lower extremity, special consideration must be given to ensure suitable and durable coverage. In the following article, we present the essential local muscle flaps for lower extremity reconstruction and discuss guiding principles for the reconstructive surgeon to consider.

Methods A thorough literature review was performed using PubMed to identify commonly used local muscle flaps for lower extremity reconstruction. Common considerations for each identified flap were noted.

Results The essential local muscle flaps for lower extremity reconstruction were identified and classified based on anatomical region of the defect to be reconstructed. General considerations and postoperative management were discussed to aid in operative decision making.

Conclusion While many factors must be taken into account when performing lower extremity reconstruction, there are numerous reliable local muscle flaps which can be used to successfully provide durable coverage for a variety of soft tissue defects of the lower extremity.

Keywords

lower extremity reconstruction - lower extremity flaps - local muscle flaps


Publication History

Received: 07 January 2020

Accepted: 23 February 2020

Article published online:
17 April 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (02) 177-187
    CrossrefPubMedGoogle Scholar
  • 2 Nahai F, Silverton JS, Hill HL, Vasconez LO. The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1978; 1 (04) 372-379
    CrossrefPubMedGoogle Scholar
  • 3 Lewis Jr VL, Cunningham BL, Hugo NE. The tensor fascia lata V-Y retroposition flap. Ann Plast Surg 1981; 6 (01) 34-37
    CrossrefPubMedGoogle Scholar
  • 4 Méndez Fernández MA, Quast DC, Geis RC, Henly WS. Distally based sartorius muscle flap in the treatment of infected femoral arterial prostheses. J Cardiovasc Surg (Torino) 1980; 21 (05) 628-631
    PubMedGoogle Scholar
  • 5 Colwell AS, Donaldson MC, Belkin M, Orgill DP. Management of early groin vascular bypass graft infections with sartorius and rectus femoris flaps. Ann Plast Surg 2004; 52 (01) 49-53
    CrossrefPubMedGoogle Scholar
  • 6 Schutzer R, Hingorani A, Ascher E, Markevich N, Kallakuri S, Jacob T. Early transposition of the sartorius muscle for exposed patent infrainguinal bypass grafts. Vasc Endovascular Surg 2005; 39 (02) 159-162
    CrossrefPubMedGoogle Scholar
  • 7 Wu LC, Djohan RS, Liu TS, Chao AH, Lohman RF, Song DH. Proximal vascular pedicle preservation for sartorius muscle flap transposition. Plast Reconstr Surg 2006; 117 (01) 253-258
    CrossrefPubMedGoogle Scholar
  • 8 Landry GJ, Carlson JR, Liem TK, Mitchell EL, Edwards JM, Moneta GL. The sartorius muscle flap: an important adjunct for complicated femoral wounds involving vascular grafts. Am J Surg 2009; 197 (05) 655-659
    CrossrefPubMedGoogle Scholar
  • 9 Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction. Plast Reconstr Surg 1993; 91 (05) 872-883
    CrossrefPubMedGoogle Scholar
  • 10 Hallock GG. The conjoint medial circumflex femoral perforator and gracilis muscle free flap. Plast Reconstr Surg 2004; 113 (01) 339-346
    CrossrefPubMedGoogle Scholar
  • 11 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57 (02) 133-143
    CrossrefPubMedGoogle Scholar
  • 12 Manktelow RT. Free muscle transplantation for facial paralysis. Clin Plast Surg 1984; 11 (01) 215-220
    CrossrefPubMedGoogle Scholar
  • 13 Yousif NJ, Matloub HS, Kolachalam R, Grunert BK, Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1992; 29 (06) 482-490
    CrossrefPubMedGoogle Scholar
  • 14 Baker PA, Watson SB. Functional gracilis flap in thenar reconstruction. J Plast Reconstr Aesthet Surg 2007; 60 (07) 828-834
    CrossrefPubMedGoogle Scholar
  • 15 Cordeiro PG, Pusic AL, Disa JJ. A classification system and reconstructive algorithm for acquired vaginal defects. Plast Reconstr Surg 2002; 110 (04) 1058-1065
    CrossrefPubMedGoogle Scholar
  • 16 Cavadas PC, Sanz-Jiménez-Rico JR. Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction. Plast Reconstr Surg 2005; 115 (04) 1070-1076
    CrossrefPubMedGoogle Scholar
  • 17 Chang SH, Chiu TJ, Tung KY, Hsiao HT. Treatment of posterior thigh radiation ulcer by a simple and easy technique of transferring island pedicled vastus lateralis muscle flap. J Plast Reconstr Aesthet Surg 2009; 62 (12) e665-e666
    CrossrefPubMedGoogle Scholar
  • 18 Ver Halen J, Yu P. Reconstruction of extensive groin defects with contralateral anterolateral thigh-vastus lateralis muscle flaps. Plast Reconstr Surg 2010; 125 (03) 130e-132e
    CrossrefPubMedGoogle Scholar
  • 19 Veber M, Vaz G, Braye F. et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg 2011; 128 (01) 181-187
    CrossrefPubMedGoogle Scholar
  • 20 Arnold PG, Mixter RC. Making the most of the gastrocnemius muscles. Plast Reconstr Surg 1983; 72 (01) 38-48
    CrossrefPubMedGoogle Scholar
  • 21 Lamaris GA, Carlisle MP, Durand P, Couto RA, Hendrickson MF. Maximizing the reach of the pedicled gastrocnemius muscle flap: a comparison of 2 surgical approaches. Ann Plast Surg 2017; 78 (03) 342-346
    CrossrefPubMedGoogle Scholar
  • 22 Hollenbeck ST, Toranto JD, Taylor BJ. et al. Perineal and lower extremity reconstruction. Plast Reconstr Surg 2011; 128 (05) 551e-563e
    CrossrefPubMedGoogle Scholar
  • 23 Hohmann E, Wansbrough G, Senewiratne S, Tetsworth K. Medial gastrocnemius flap for reconstruction of the extensor mechanism of the knee following high-energy trauma. A minimum 5 year follow-up. Injury 2016; 47 (08) 1750-1755
    CrossrefPubMedGoogle Scholar
  • 24 Yamada S, Okamoto H, Sekiya I. et al. Anatomical basis of distally based anterolateral thigh flap. J Plast Surg Hand Surg 2014; 48 (03) 197-200
    CrossrefPubMedGoogle Scholar
  • 25 Auregan JC, Bégué T, Tomeno B, Masquelet AC. Distally-based vastus lateralis muscle flap: a salvage alternative to address complex soft tissue defects around the knee. Orthop Traumatol Surg Res 2010; 96 (02) 180-184
    CrossrefPubMedGoogle Scholar
  • 26 Song P, Pu LLQ. The soleus muscle flap: an overview of its clinical applications for lower extremity reconstruction. Ann Plast Surg 2018; 81 (6S): (Suppl. 01) S109-S116
    CrossrefPubMedGoogle Scholar
  • 27 Houdek MT, Wagner ER, Wyles CC, Sems SA, Moran SL. Reverse medial hemisoleus flaps for coverage of distal third leg wounds: a technical trick. J Orthop Trauma 2016; 30 (04) e138-e142
    CrossrefPubMedGoogle Scholar
  • 28 Pu LL. Further experience with the medial hemisoleus muscle flap for soft-tissue coverage of a tibial wound in the distal third of the leg. Plast Reconstr Surg 2008; 121 (06) 2024-2028
    CrossrefPubMedGoogle Scholar
  • 29 Tobin GR. Hemisoleus and reversed hemisoleus flaps. Plast Reconstr Surg 1985; 76 (01) 87-96
    CrossrefPubMedGoogle Scholar
  • 30 Pu LL. Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: the role of local muscle flaps revisited. J Plast Reconstr Aesthet Surg 2010; 63 (08) e605-e610
    CrossrefPubMedGoogle Scholar
  • 31 Reddy V, Stevenson TR. MOC-PS(SM) CME article: lower extremity reconstruction. Plast Reconstr Surg 2008; 121 (04) 1-7
    CrossrefPubMedGoogle Scholar
  • 32 Hallock GG. Sagittal split tibialis anterior muscle flap. Ann Plast Surg 2002; 49 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 33 Huisinga RL, Houpt P, Dijkstra R, Storm van Leeuwen JB. The distally based sural artery flap. Ann Plast Surg 1998; 41 (01) 58-65
    CrossrefPubMedGoogle Scholar
  • 34 Reading G. Instep island flaps. Ann Plast Surg 1984; 13 (06) 488-494
    CrossrefPubMedGoogle Scholar