Endoscopic Concurrent Gastrocnemius Muscle Resection and Soleus Muscle Neurectomy for Severe Muscular Calf Hypertrophy.

Abstract

Selective neurectomy or muscle resection techniques for calf reduction conventionally focuses on the gastrocnemius muscle. Nonetheless, the underlying soleus muscle plays an important role in muscular calf hypertrophy. In our experience, the results of calf reduction have been suboptimal in patients with severe muscular calf hypertrophy who had undergone gastrocnemius muscle resection only. This study aimed to describe a new calf reduction method that employs concurrent gastrocnemius muscle resection and soleus muscle neurectomy using an endoscope-assisted single-incision approach in patients with severe muscular calf hypertrophy. One hundred thirty-nine patients who underwent simultaneous gastrocnemius muscle resection and soleus muscle neurectomy for severe muscular calf hypertrophy from March 2017 to June 2020 were retrospectively analyzed. After combined gastrocnemius resection (mean weight per calf was 349g) and soleus neurectomy, about 3.8 to 8.2 cm (mean: 6.4 cm) or 12.8% to 24.3% (mean: 16.6%) of the calf was reduced. Three patients each had cellulitis, hematoma, and seroma. Two patients had traction injury to the sural nerve, whereas one patient developed mild depression. One patient developed Achilles tendon rupture at 2 months postoperatively. None of the patients complained of functional impairment with respect to easy fatigability, stability, gait, or sport activities at 6 months postoperatively. This study is the first to combine gastrocnemius muscle resection with selective soleus muscle neurectomy to achieve the most efficient calf reduction for severe muscular calf hypertrophy.