Distal third traumatic and tumor defects traditionally have been reconstructed with microvascular free flap reconstruction. In many non-academic centers, private practitioners find this onerous and difficult to achieve without a set microvascular team. Thus, local flaps could potentially be possible alternatives for reconstruction of these difficult areas.

Historically, distally based soleus flaps have received minimal attention due to variable survival rates and questions about overall blood supply. We present our clinical series of eight distally based soleus flaps for reconstruction of ankle and lower third traumatic and tumor defects.

A series of eight patients over a one year period were deemed excellent candidates for distally based soleus flaps. They will be presented with follow-ups for up to 1½ years.

The data will show that distally based soleus flaps are an excellent alternative for reconstruction in this difficult distal third of the lower extremity. We will discuss the techniques, pearls and pitfalls, in order to have a solo practitioner be comfortable with these reconstructive challenges.