The medial and lateral gastrocnemius muscles are supplied proximally by the sural arteries emanating from the popliteal artery.

The flap easily covers the tibial plateau region, and the muscle’s origin on the distal femur can be released, allowing the reach to be extended to the patella and suprapatellar regions. The soleus muscle flap is the workhorse of the central third of the leg, and its blood supply is derived principally Inhibitors,research,lifescience,medical from proximal branches of the posterior tibial artery and peroneal artery. Secondary perfusion is provided by distal branches of the posterior tibial artery. In well-selected patients without significant trauma or vascular disease, it is possible to split the soleus muscle and perform a reverse transposition to cover distal third defects. The great majority of defects in the distal third of the leg, however, are best managed with microsurgical free-tissue transfer (free flaps) (Selleck Erastin Figure 1), although reverse neuro-fasciocutaneous flaps (reverse sural flaps) can provide Inhibitors,research,lifescience,medical a reasonable Inhibitors,research,lifescience,medical alternative in select patients. The latissimus dorsi, rectus abdominis, gracilis, serratus anterior, and anterolateral thigh with segmental

vastus lateralis are frequent donor sites. The flaps can incorporate a skin island or be covered with skin graft as determined by the size and topography of the defect. Blood supply is restored Inhibitors,research,lifescience,medical with an arterial and venous microvascular anastomosis, which can be achieved in an end-to-end or end-to-side fashion, typically using 9-0 nylon under the guidance of an operating microscope or high power loupes. Free muscle flaps have proved more resistant to the effects of cigarette smoking than local skin and fasciocutaneous flaps and have been successfully Inhibitors,research,lifescience,medical employed

in patients with diabetes and peripheral vascular disease.4 Figure 1 (A, B) Complex plantar and dorsal foot wounds with exposed bone and tendon. (C) Reconstruction with split latissimus dorsi free flap and skin graft. (D) Late postoperative very follow-up after free muscle flap reconstruction. Illig et al evaluated outcomes and prognostic factors in patients who underwent a combined free tissue transfer and distal vascular bypass to manage otherwise nonreconstructible infrainguinal arterial occlusive disease with associated advanced tissue necrosis.5 Following wound debridement, ischemia was managed by an infrainguinal bypass with the distal anastomosis achieved below the knee in the majority of patients. The microvascular arterial anastomosis was made to the bypass graft in most patients. The patient group had multiple comorbidities including diabetes mellitus, advanced age, end-stage renal disease (ESRD), and osteomyelitis. All patients would have required a minimum of a below-knee amputation (BKA) if no intervention was initiated.