الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Soft tissue defects of the distal lower extremity are difficult wounds to treat. This area of the leg has a thin integument, relatively superficial tendons and a paucity of soft tissue. For these reasons, injuries often expose vital structures and leave the plastic surgeon with a difficult decision regarding appropriate wound management.
Over the last several decades, microsurgical free flap techniques looked to supplant pedicled muscle flaps for coverage of foot and ankle defects. However, recent studies indicate that local flap options have seen resurgence in popularity, concurrent with a better understanding of lower leg vascular anatomy and improved wound care technology.
Pedicled muscle flaps afford the surgeon a reliable and relatively straightforward reconstructive option for patients with osteomyelitis or those who may not tolerate a larger operation. The usefulness of a muscle flap to cover exposed tendon and bone is not only from its ability to physically cover the defect, but also from its ability to introduce a new vascular bed to potentiate wound healing.
Reconstruction of soft tissue defects of the lower leg starts with debridement of all necrotic and devitalized tissues and it may be repeatedly done in heavily contaminated wounds.
The most significant advantage of a hemisoleus muscle flap is the preservation of foot planter flexion powered by the hemisoleus muscle belly left in situ. The medial part of the muscle is supplied throughout its length by perforators arising from the posterior tibial vessels. This constant feature makes the medial part of the muscle, the medial hemisoleus, reliable as aproximally or distally based flap
This study included 21 patients with moderate sized lower 1/3 leg defects who required reversed hemisoleus flap admitted to Plastic & Reconstructive Surgery Department in Menoufia University Hospital. The study duration was from August 2017 to october 2018.
Patients’ age ranged from 16 to 60 years old. 18 cases were males and 3 cases were females. 10 cases were presented after run over , 4 cases were presented after crush trauma,3 after road traffic accidents, 2 patients with exposed plates, 1 patient with degloving injury and 1 patient with post burn scar. 14 cases were associated with skeletal fractures, while 7 were not. 13 cases were associated with comorbidities, while 8 cases were free.
We did not had any complication among the studied patients in 66.67% of them but unfortunately 9.52% of them had wound infection and other 4.76% had their graft rejected then regrafted and 9.52% had delayed graft take and 4.76 % showed partial flap necrosis that needed other procedures and only 4.76 % had the flap necrosed that needed other procedures.
Postoperative outcome among this group showed that complete success in 18 cases (85.71 %) with complete coverage of the defects, good esthetic appearance and without morbidity in donor and recipient site. 3 cases (14.29%) needed other procedures for coverage of the defect.
According to the donor site morbidity the preservation of lateral belly of the muscle preserve the planter flexion of the foot. According to the esthetic appearance at the donor site only longitudinal nice scar at the incision site through which muscle flap was harvested and no morbidity at donor site of STSG.