Authors: Ali Yavari, Omid Etemad, Changiz Delavari, Hojjat Molaei.
Background: Lower limb injuries increased challenges about reconstruction of complex open fractures with soft tissue defects. There are numerus solutions and gastrocnemius flap is mostly used by surgeons. Only- muscle flap is available and can be harvested easily, but musculocutaneous flap needs more experience to preserve vital dermal perforators.
Patients and Methods: 5 patients with proximal leg and knee area soft tissue defects treated as reconstruction by musculocutaneous gastrocnemius flap. During surgery considerations were toward saving dermal perforators from muscle and adjacent sural nerve. Data related to technique and outcomes were gathered.
Results: 5 patients were evaluated who (100%) were men. The average age was 38.9 yrs old (min. 24 vs max.65). 2 patients (40%) had defect of proximal leg and 3 ones (60%) had defect of middle leg. Defects were mostly due to trauma. The average size of skin defect was approximately 1020 mm2. 2 cases (40%) had complication as wound infection and it seems it was due to partial skin dehiscence. One patient had defect on lateral leg and lateral belly selected for reconstruction with acceptable skin blood supply (20%).
Discussion: Gastrocnemius muscle is a superficial muscle of posterior calf, can be reached easily by direct incision and harvested straight-forwardly, as its blood supply is type 1 and transferred to the site of defect. Surgeons mostly prefer to use muscle flap and skin graft over it to have reassurance about fate of skin coverage. Assessments of fresh cadavers and clinical cases on combined muscle and skin flap, demonstrated some reliable perforators from gastrocnemius muscle and sural nerve collateral perforators may preserve proper blood supply and better flap survival.
Conclusion: Musculocutaneous gastrocnemius flap with reliable perforators is a work horse in proximal leg defects. Preserving more dermal perforators warranty flap survival and prevent extra skin graft.
View/Download pdf