The reconstructive ladder principle guides flap selection. A patient with a 4 × 6 cm defect over the mid-tibia following trauma with exposed hardware and compromised local tissue has failed split-skin grafting. Which single flap is the workhorse muscle flap for mid-tibial defects in reconstructive surgery?

• A Gastrocnemius muscle flap
• B Free anterolateral thigh (ALT) flap
• C Soleus muscle flap ✓
• D Reverse sural flap

Explanation

The soleus muscle flap is the workhorse for reconstruction of middle-third tibial defects. Its segmental blood supply (from the posterior tibial and peroneal arteries) allows a hemisoleus flap to be raised and transposed to cover mid-tibial defects. The gastrocnemius muscle flap (medial and lateral heads) is used for upper-third tibial defects (proximal tibia/knee). The reverse sural flap is reliable for lower-third (distal) tibial and heel defects. Free flaps (ALT, gracilis) are considered when local flaps are inadequate or in complex cases. The three-zone rule (upper = gastrocnemius, middle = soleus, lower = free flap/reverse sural) is a standard mnemonic.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.