Modified lateral gastrocnemius myocutaneous flap with extended anterior and/or inferior boundary

Ping Peng,Zhaobiao Luo,Lei Zheng,Zhonggen Dong,Shu Cao,Qiang Xu,Lihong Liu,Jianwei Wei

doi:10.1038/s41598-022-05093-2

Abstract

There is little information regarding the boundaries of the lateral gastrocnemius myocutaneous (LGM) flap. The aim of this study was to introduce the modified technique of the LGM flap with extended anterior and/or inferior boundaries and its anatomical basis. Five fresh lower limb specimens were perfused and radiographed. Between December 2003 and August 2018, 27 modified LGM flaps with extended anterior and/or inferior boundaries were raised in 27 patients to reconstruct the soft tissue defects over the middle and upper leg, knee, and lower thigh. Both the lateral popliteal cutaneous artery and musculocutaneous perforators from the lateral sural artery had rich linked arteries communicating with the chain-linked arterial network around both the posterolateral intermuscular septum and the sural nerve, and they also had rich transverse communicating arteries connecting with the perifascial arterial network overlying the anterior compartment in the upper and middle calf. Continuous fascial arterial networks were extended up to the level at the intermalleolar line. Twenty-three flaps survived uneventfully, 2 flaps displayed distal de-epithelialization, and 2 flaps (7.41%) developed partial necrosis. Osteomyelitis was cured successfully in all patients, and no relapse of infection was encountered during the follow-up period. Multiple feeder arteries are the arterial anatomic basis of the modified LGM flap. The modified LGM flap with extended anterior and/or inferior boundaries is feasible, and the modified flap with extended anterior boundaries is safe and reliable.

Highlights

There is little information regarding the boundaries of the lateral gastrocnemius myocutaneous (LGM) flap
The medial gastrocnemius myocutaneous flap with a larger dimension and wider reach was applied more frequently to cover these defects[7,8], while the lateral gastrocnemius myocutaneous (LGM) flap was used to resurface the defects when the defects were predominantly located in the lateral aspect of the regions mentioned above or when the medial gastrocnemius myocutaneous flap was unsuitable because its integrity was d estroyed[9,10]
We observed that some remnant skin overlying the anterior compartment of the leg usually existed between the lateral border of the soft tissue defect and the anterior edge of the fibula

Summary

Introduction

There is little information regarding the boundaries of the lateral gastrocnemius myocutaneous (LGM) flap. Between December 2003 and August 2018, 27 modified LGM flaps with extended anterior and/or inferior boundaries were raised in 27 patients to reconstruct the soft tissue defects over the middle and upper leg, knee, and lower thigh. We observed that some remnant skin (skin bridge) overlying the anterior compartment of the leg usually existed between the lateral border of the soft tissue defect and the anterior edge of the fibula (i.e., anterior boundary of the classical LGM flap) This skin bridge usually discommodes the design and transfer of the flap, and it has to be removed or de-epithelized prior to flap transposition. The aim of this study is to introduce the modified technique of the LGM flap with extended anterior and/or inferior boundaries and its anatomical basis, as well as report the outcomes of the modified flap for reconstructing defects

Objectives

Methods

Results

Conclusion