A reverse triangular soleus flap based on small distal communicating arterial branches

We report a 25-year-old woman who suffered traumatic damage to the medial malleolar area. Arteriography revealed a posterior tibial artery occlusion at the ankle. The predominant pattern of medial soleus vascularization was revealed during surgery. A reverse medial soleus flap including the posterior tibial pedicle was elevated. The lateral soleus was gradually elevated with it to ensure a full soleus base of the flap, resulting in a triangular shape. The flap survived completely. Both the triangular shape and the inclusion of the posterior tibial artery pedicle contributed the success of the flap by improving both the arterial supply and the venous drainage along the entire muscular flap.