Arterial supply of the soleus muscle: anatomical study of fifty lower limbs

Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. The arterial blood supply of the soleus muscle was studied in 50 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The distance of the origin of the perforators was measured from fixed bony landmarks. Branches of the popliteal artery trunk, the posterior tibial artery, and the peroneal artery supplied the soleus muscle. The number of branches to the soleus muscle from these main arteries were analyzed. The medial part of the muscle was supplied throughout its length by perforators arising from the posterior tibial artery. This constant feature makes the medial part of the muscle reliable as a proximally or distally based flap. The average distances of the lower perforators arising from the posterior tibial artery were 6.5 cm, 11.6 cm, and 16.8 cm from the medial malleolus. The branches of the peroneal artery were mostly distributed in the upper half of the muscle. These large pedicles allow a composite transfer of the soleus muscle with the fibula. Lower perforators were demonstrated to arise from the peroneal artery in 60% of the limbs but the scarcity of perforators in this region limits the clinical usefulness of an inferiorly based lateral hemisoleus flap. The study demonstrates the distribution of arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. The average numbers of the perforators arising from the vessels and their distribution have been highlighted.