Skin defects of the anterior central region of the lower leg accompanied by bone and foreign body exposure may be difficult to repair due to a lack of soft tissue. Since Ger reconstructed lower limb ulcer with the soleus and medial gastrocnemius muscles in 1966, reconstructions with muscle flaps have been frequently reported.
We encountered 3 patients for whom reconstruction with soleus, medial gastrocnemius, and inferiorly based gastrocnemius muscle flaps was applied to skin defects of the lower leg. Although each muscle flap has advantages and disadvantages, the flaps were useful. The conventional gastrocnemius muscle flap was previously not suitable for tissue defects in the central region of the lower leg, but the inferiorly based gastrocnemius muscle flap could be applied because of the presence of its pedicle on the distal side. This may be a useful muscle flap applicable for many cases because the surgical technique is simple and the operative time is short due to the absence of complicated dissection in the procedure, unlike the preparation procedure of a soleus muscle flap.

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The determination of whether lower limb blood flow will improve after endovascular treatment is difficult when predicting wound healing or the avoidance of unnecessary amputation in critical limb ischemia (CLI) patients. The time taken for skin perfusion pressure (SPP) values to increase after endovascular treatment has also not been established.
We examined the SPP value differences before and after (a few days, two weeks, and four weeks) endovascular treatment (⊿SPP) in CLI patients with lower limb skin ulcers. Patients were classified according to direct or indirect endovascular revascularization based on the angiosome concept. ⊿SPP values increased after endovascular treatment in the direct group, reaching a maximum after two weeks, but no significant differences were noted between a few days and two weeks or four weeks after treatment. Among dialysis patients, ⊿SPP values gradually increased over four weeks after endovascular treatment. However, among non-dialysis patients, ⊿SPP values increased to the same extent as in all cases taken together in both groups.
Surgery can be performed a few days after direct endovascular treatment in CLI patients if blood flow improves. However, in dialysis patients, surgery should be performed once SPP values increase sufficiently after endovascular treatment.

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