الفهرس 
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Abstract
The soleus muscle, one of the components of the superficial posterior compartment of the leg, was used initially as a local flap, as described by Ger and later by Mathes & Nahai.
The proximally based medial hemisoleus muscle flap can be a reliable local option for soft-tissue coverage of a less extensive tibial (no more than 60 cm2 in size) wound in of the middle thirds of the leg with good outcome and minimal functional morbidity.
It may potentially offer a cost-effective approach for limb salvage and can be performed by most reconstructive surgeons. Concerns for viability are virtually nonexistent for proximally based soleus flaps
The combined medial gastrocnemius or other local flap and medial hemisoleus muscle flaps can be a valid option for soft tissue coverage of an extensive mid-tibial wound of the leg when both local muscle flaps are not traumatized. Such an approach offers a relatively simple but more cost effective way to manage this complex clinical problem and should be revisited by reconstructive surgeons
The reliability of the distally based pedicled hemisoleus flap for coverage of relatively small medial distal third leg wounds has been continuously debated among reconstructive surgeons. Whereas some investigators report that the distally based hemisoleus can be elevated safely, other authors argue that the flap’s retrograde blood supply is problematic.
That application of angiosome principles may help surgeons to better design the distally based hemisoleus flap so that outcomes are optimized.
Fortunately, the distal flap necrosis is usually insignificant and can be easily treated with debridement. The flap can then be re advanced adequately to cover the tibial wound
The distally based pedicled hemisoleus flap can be reliable in most healthy, compliant patients with a tibial wound smaller than 50 cm2.
However, the flap should not be used in patients with significant peripheral vascular disease because of the potential poor inflow of the posterior tibial artery or in those with significant diabetes because of the potential small vessel disease in those perforators. The initial venous congestion may also become a problem in certain patients such as smokers.
we agree that the soleus muscle provides another useful option, along with free flaps, for distal third lower extremity coverage, we believe that free flap coverage continues to be the most reliable option for high-risk patients with traumatic injuries.
With wider application of soleus flap coverage, preoperative studies such Conventional arteriography and magnetic resonance imaging may prove useful as they can reliably identify the soleus muscle and provides a nonoperative method for evaluation of potential feasibility for its use as a local muscle flap for distal lower extremity defects.
The island soleus muscle flap was introduced by Yajima et al. based on one or two minor perforators. It was described as being reliable flap specified only to small pretibial skin defects using a small portion of the soleus muscle with no functional deficit.
The flap has reliable vascularity. The perforators can be seen easily during dissection. This gives the surgeon the free hand to change his surgical plan if the required perforators are not available due to anatomical variation or due to injury from the trauma.
It can cover small and large pretibial skin defects. It can be advanced to cover medial pretibial skin defects and if mobilized from the posterior tibial nerve, it can cover anterior tibial skin defects.