Restoration of middle third leg soft tissue defects using a distally based hemigastrocnemius flap

Abstract

Background Traumatic wounds, burns, tumor resections, and tibial fractures frequently lead to exposure of the tibia. Due to limited mobility and a paucity of overlying skin, flap coverage is generally required even for a small defect in the pretibial area. Soft tissue coverage of these defects is a must as any exposed bone that is not covered by vascularized soft tissue is at risk of osteomyelitis, bone necrosis, and sepsis.Objective This study aimed to evaluate the coverage of middle third defects of the leg using an inferiorly based hemigastrocnemius muscle flap.Patients and methods This prospective study was carried out at the Plastic, Reconstructive and Burn Department, Al-Azhar University Hospitals. This study included 20 patients with soft tissue defects at the middle third leg.Results In our study, 90% of the patients underwent reconstruction with a medial head distally based gastrocnemius flap, while the rest, 10%, underwent reconstruction with a lateral head distally based gastrocnemius flap. The majority of our patients, 65%, did not develop any complications. Unfortunately, 10% of the patients developed graft rejection and 10% developed partial flap necrosis, while 5% developed wound infection, 5% developed hematoma and 5% showed delayed graft take; all of these patients were managed early, and in terms of complications, only 5% of the patients had a hypertrophic scar of the donor site and 5% of the patients had hyperkeratosis. Most of our patients, 90%, were satisfied with the results, with only 10% being unsatisfied with the shape of postreconstructive recipient or donor sites.Conclusion The inferiorly based hemigastrocnemius muscle flap based on the vascular bundles between the two heads can be useful for reconstruction of the middle third of the leg. It is a simple technique allowing rapid, durable, and reliable coverage of these defects without sacrificing a nerve or a major vessel to the foot.