Muscle transposition flaps for coverage of lower extremity defects: anatomic considerations.

Full thickness skin loss in the lower extremity presents special difficulties to the surgeon and his patient. Soft tissue in juxtaposition to the wound is usually remarkably thin and poorly vascularized. Moreover, the base of the wound very often is exposed, dead, infected bone. These chronic, persistent, economically debilitative ulcerations, traumatic, vascular, metabolic, or infectious in origin, classically are managed by split thickness skin grafts or distant flaps. In 1966, Ralph Ger suggested the use of muscle as a transposed flap as a practical single stage technique to accomplish coverage for these difficult ulcerative lesions.