Calf Reduction Research Articles

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

Selective neurectomy or muscle resection techniques for calf reduction conventionally focus on the gastrocnemius muscle. However, the underlying soleus muscle plays an important role in muscular calf hypertrophy. In the authors' experience, the results of calf reduction have been suboptimal in patients with severe muscular calf hypertrophy who underwent gastrocnemius muscle resection only. This article describes a new calf reduction method that uses concurrent gastrocnemius muscle resection and soleus muscle neurectomy using an endoscope-assisted single-incision approach in patients with severe muscular calf hypertrophy. A total of 139 patients who underwent simultaneous gastrocnemius muscle resection and soleus muscle neurectomy for severe calf hypertrophy from March of 2017 to June of 2020 were retrospectively analyzed. After combined gastrocnemius resection (mean weight per calf, 349 g) 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. Complications included cellulitis, hematoma, seroma, and mild depression ( n = 1 each). Two patients had traction injury to the sural nerve. One patient developed Achilles tendon rupture at 2 months postoperatively. No patient 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. Therapeutic, IV.

Selective Neurocoagulation of Gastrocnemius and Lateral Soleus Muscles for Calf Reduction.

Various methods have been attempted to improve the size and shape of calves, and selective neurocoagulation of the calf muscle using radio frequency (RF) is one of them. The objective of this study was to provide information about the efficacy and safety of selective neurocoagulation of the gastrocnemius (GCM) and lateral soleus muscles using RF for cosmetic purposes. A retrospective analysis of 345 patients (686 legs), who underwent selective neurocoagulation using RF at our clinic for calf hypertrophy between January 2018 and March 2020, was performed. We measured the circumference of the calf and thickness of the medial GCM using ultrasonography before and after the procedure. Patient satisfaction and side effects were investigated through interviews. The average calf circumference had decreased by 2.9 ± 1.1 cm (GCM-only group) and 3.0 ± 1.4 cm (GCM + lateral soleus group), at 6 months after the procedure, and there was a statistically significant decrease in both groups. At 12 months after the procedure, the calf circumference slightly increased compared to that at 6 months, but the circumference was still smaller than that before the procedure. Most patients were satisfied with the size and contour of their calves and there were no severe adverse effects. Motor nerve coagulation using RF was effective in reducing the volume of the GCM and lateral soleus muscles and softening the contours of the calf. It was safe and without side effects in most patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Simultaneous calf reduction and contouring with customized differential subtotal gastrocnemius resection and muscle transposition: Analysis of 200 cases

Oversized muscular calves can cause severe emotional distress. Total, partial, and subtotal resections of the gastrocnemius muscle for calf reduction have been described. However, the amount of muscle resected may be inappropriate, and the resultant leg contour may not be straight or esthetically pleasing enough. This study aimed to describe a technique of customized differential subtotal gastrocnemius resection and muscle transposition. A total of 200 patients who underwent customized differential subtotal gastrocnemius resection and muscle transposition for hypertrophic muscular calves from July 2013 to June 2016 were included in the study. A total of 148 patients underwent subtotal resection of both heads, and calf reduction ranged from 3.2 to 7.2 cm (mean 14.8%). Forty-two patients underwent subtotal resection of the medial head alone, and calf reduction ranged from 2.8 to 5.5 cm (mean 9.2%). Ten patients underwent subtotal resection of the lateral head alone, and calf reduction ranged from 1.2 to 2.1 cm (mean 4.6%). The medial gastrocnemius muscle was subtotally resected in 190 (95%) patients. In 130 (65%) patients, the preserved medial gastrocnemius muscle was transposed superomedially to achieve a straighter medial contour. None of the patients complained that their legs were too thin because of over-reduction. Cybex test showed that near-total muscle strength recovery was achieved within 6 months. Customized differential subtotal gastrocnemius resection together with muscle transposition resulted in enhanced calf reduction with straighter leg contour, without any impairment of the leg function. This approach may be more appealing to both patients and surgeons.

Medial gastrocnemius resection for calf reduction by using a popliteal mini-incisional approach in Asians

To create a new approach of resecting medial gastrocnemius for calf reduction and to meet the increasing requirement of the beauty standard of calf sliming in Asian. Twenty patients with 39 calves underwent gastrocnemius resection for calf reduction. Under general anesthesia, a 5cm incision, along the popliteal crease, was made down to the sub-popliteal deep fascia on a prone position. The medial belly of the gastrocnemius muscle was then dissected, in a blunt way, from the popliteal fossa down to the Achilles tendon around the muscular belly when its neurovascular bundle was ligated and cut off. Thereafter, the medial gastrocnemius was pulled out of the wound and incised transversely off at the level of the popliteal fossa while the attachment to the Achilles was transected with a long rectangular scissors. The incisional wound was finally closed in layers. Twenty patients with 39 calves were treated using the above-mentioned technique without severe complications. The harvested gastrocnemius muscle weighed 192.1g in mean (from 104.5g to 307.6g). The calf circumference was significantly decreased from 36.3cm in mean to 32.8cm in mean before and after the operation (p <0.05). The above-mentioned technique may be a safer, simpler, and more efficient method for calf reduction with less morbidity of the potential complications, in comparison with the traditional techniques.

Single Incision Endoscope-Assisted Gastrocnemius Muscle Resection for Calf Hypertrophy: Analysis of 300 Cases.

Muscular calf hypertrophy can cause severe psychological distress. Total or subtotal resection of the gastrocnemius muscle results in significant calf reduction. However, both techniques require a second incision of 5 and 2 cm, respectively, at the posterior mid-calf. The resultant mid-calf scar is more difficult to conceal when wearing short skirts or pants. The authors sought to describe the technique of endoscope-assisted gastrocnemius muscle resection to obviate the need for a mid-calf scar and to review the outcomes of patients who underwent this procedure. A retrospective study of 300 patients in a single center in Taiwan who underwent endoscope-assisted subtotal resection of the gastrocnemius muscle for hypertrophic muscular calves, between March 2015 to June 2019, were included in this study. The combined weight of the resected gastrocnemius muscle ranged from 156 to 484 g per calf (mean = 276 g). The mean maximal calf circumference was 36.1 cm preoperatively and 30.9 cm postoperatively. The calf reduction achieved was 3.0 to 8.1 cm (mean = 5.2 cm), or 8.9% to 19.8% (mean = 14.4%). The complications were minor, and the rate was low (2%). As for the popliteal fossa scar, 6 patients underwent further treatment of their hyperpigmented or hypertrophic transverse scar. There were no complaints of impaired leg function regarding gait or sports activities 3 to 6 months postoperatively. At present, gastrocnemius muscle resection remains unrivaled in its ability to achieve calf reduction. The surgery is now much more appealing to patients as a result of employing the endoscope-assisted technique to obviate the mid-calf scar.

Financial losses and cost benefit analysis of controlling anestrus in dairy animals of Punjab

The main objective of this study was to evaluate the financial losses associated with anestrus and cost benefit analysis of various factors controlling this disease in dairy animals of Punjab region. The overall economic loss incurred by dairy farmers due to anestrus irrespective of species of animals was ` 24,362. The mean economic losses per animal per year was almost same in crossbred cattle (` 27,511.48±1,227.60) and buffaloes (` 27,038.69±1,128.05) and lower in indigenous cattle (` 18,296.95±1,317.53). When the average annual losses due to different components were estimated, the largest component was due to replacement cost followed by milk yield loss cost, future calf reduction and veterinary charges. Among different agro-climatic zones (ACZs), highest loss was observed in Central Plain Region (` 27,384.63±2,407.03) and the least affected zone was Flood Plain Region (` 19,135.6±4,326.50). While controlling anestrus at farm level through different control measures, the overall benefit cost ratio was estimated to be 5.33. The projected loss in Punjab state due to anestrus in dairy animals was estimated to be ` 2135.79 crore. It may be concluded that the mean economic losses per animal per year was higher in crossbred cattle and buffaloes, where the largest component was due to replacement cost followed by milk yield loss, future calf reduction and veterinary charges. In order to control economic losses due to anestrus, it is important to improve all aspects related to heat detection, and to provide appropriate preventive or therapeutic measures.

A Study of Tibial Nerve in the Popliteal Fossa Along With Its Variations in Its Branching Pattern

Background: A detailed Knowledge of these variations in motor branching patterns will help the surgeons when certain procedures are done for calf reduction and also when selective neurectomy is required. It is also required by the anesthetists to give neurolytic blocks. Subjects and Methods: 40 formalin-fixed lower limbs of adult human cadavers were selected. The origin of the tibial nerve, variations in a branching pattern, number of muscular branches given was studied by dissection. The Level of origin of these nerves was taken to the apex of the head of the fibula (AHF). Results: In 70 % of specimens the origin of the Tibial Nerve was &lt; 12 cm and in 30 % it was between 12-24 cm above the level of AHF. In 10% of cases, the sural nerve originated from the nerve to the medial head of gastrocnemius (MHG). In 82.5% of specimens, the MHG received one branch from the tibial nerve and in 17.5% it received two branches. The lateral head of Gastrocnemius (LHG) received one branch from the tibial nerve. In 10%, there was a common branch for the LHG and the soleus muscle. 90% of specimens had one branch and 10% had two branches that supplied the soleus muscle. A single branch supplied the plantaris muscle. The popliteus muscle also received a single branch. Conclusion : The results in the study provide information that is required by the anatomists, surgeons, radiologists and anesthetists.

Botulinum Toxin Injections for Leg Contouring in East Asians.

A common aesthetic concern among East Asian women is enlarged calves. Although surgical resection has been a traditional treatment option, botulinum toxin injections into the gastrocnemius muscle are an emerging, noninvasive alternative. To perform a literature review on botulinum toxin injections for leg contouring. A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane's CENTRAL database to identify articles relating to combinations of the terms botulinum toxin, gastrocnemius, calves, and leg contouring. Based on the limited publications to date, the authors prepared a review on how to treat an enlarged calf with botulinum toxin including injection techniques, anticipated efficacy, outcome monitoring, and potential side effects. Botulinum toxin injections for calf reduction are an emerging, noninvasive treatment option. Studies to date suggest that it is an efficacious method with few immediate side effects. Future areas for investigation include defining the criteria for calf hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of injections.

Calf Reduction by Partial Resection of Gastrocnemius Using a Suction-Assisted Cartilage Shaver.

Long-term aesthetic reduction of the legs in Asians is gaining increasing popularity among cosmetic patients. Current treatment options include botulinum toxin injection, radiofrequency, neurectomy, and total, subtotal, or partial muscle resection of the gastrocnemius. Partial resection using Kelly forceps was introduced in 2000. This article presents the use of a suction-assisted cartilage shaver to perform partial resection, describing the procedures and shaver modifications and evaluating its use. A retrospective review of 71 cases with a minimum 6-month follow-up (average, 36.5 months; range, 6 to 160 months) was performed. Twenty partial calf reductions were performed with a short shaver, 27 with a long shaver, and 24 with an endoscope-guided long shaver. Mean reduction of calf circumference was 2 cm (range, -1 to 6 cm); the mean preoperative and postoperative calf circumferences were 35.8 cm and 33.8 cm, respectively. Mean tissue reduction per calf was 110 g (range, 25 to 300 g).Two patients developed larger calves after surgery, one because of weight gain and the other because of weight training. Complications included surface irregularity (n = 4, 5.6 percent), numbness over the lateral ankle or lateral foot (n = 9, 12.7 percent), hematoma clot requiring surgical evacuation (n = 11, 15.5 percent), prolonged seroma (n = 2, 2.8 percent), and left ankle plantar-flexion contracture due to tight, sustained postsurgery bandaging (n = 1, 1.5 percent). Scar-related complications were hyperpigmentation (n = 6, 8.5 percent), depressed scars (n = 5, 7 percent), and hypertrophic scars (n = 2, 2.8 percent). Short, long, and endoscope-guided long suction-assisted cartilage shavers for partial resection of calf muscles can be used effectively to reduce the calf. Several mostly treatable complications were noted. Therapeutic, IV.

Variations in the branching pattern of the tibial nerve in the posterior compartment of the leg

Background: Tibial nerve is the largest branch of sciatic nerve. It innervates muscles of the posterior compartment of the leg. Knowledge of the variations in motor branching pattern may help the surgeons when certain procedures are done for calf reduction and also for spastic equinus foot where selective neurectomy is required. It is also required for anesthetists for inducing neurolytic blocks. The aim of the present study was to study the variations in its branching pattern of the tibial nerve in the posterior compartment of the leg. Materials and Methods: The study was done by dissecting forty formalin-fixed lower limbs from twenty adult human cadavers. The origin of tibial nerve, variations, branching pattern, number of muscular branches and termination of the tibial nerve were studied. The level of origin of these nerves was taken in relation to the apex of head of fibula. Results: 57.5% showed that the origin was <12 cm and 42.5% were between 12 and 24 cm above the level of apex of head of fibula. The flexor hallucis longus received one branch in 70% and two branches in 30% of the specimens. Forty percent of the branches showed two or three divisions. The flexor digitorum longus received one branch in 95% and two branches in 5% of the specimens. Eighty percent of the branches of the muscle showed 2–4 divisions. 82.5% of nerve to soleus muscle had one branch and 17.5% had two branches. In 17.5% of the specimens, nerve to soleus originated from the nerve to the lateral head of gastrocnemius. Thirty percent of the branches showed 2–3 divisions. All specimens had one branch which supplied the tibialis posterior muscle and 47.5% of the branches showed 2–3 divisions. In 77.5% of the specimens, the termination occurred above the malleolar calcaneal axis. Conclusion: The flexor hallucis longus, flexor digitorum longus, and soleus muscle had one or two branches from tibial nerve. Single branch innervates tibialis posterior. Nerves to flexor hallucis longus, tibialis posterior, and the soleus had up to three divisions and nerve to flexor digitorum longus had up to four divisions.

A multicenter, randomized, open-label comparative study of prabotulinumtoxinA with two different dosages and diverse proportional injection styles for the reduction of gastrocnemius muscle hypertrophy in Asian women.

A botulinum toxin (BTX) injection can be a simple and safe alternative to calf reduction surgery or liposuction without interrupting daily life. However, its optimum dosage and clinical response are not yet well known. A total of 40 patients with bilateral gastrocnemius muscle hypertrophy were enrolled in this study. All volunteers were randomly categorized into four groups and then administered different amounts of BTX (160 U and 200 U) on the medial and lateral aspects of their calves. All subjects showed clinical improvement with a reduction in the gastrocnemius muscle size after BTX injection. However, our results showed that the decrease in leg circumference was not dose dependent. No side effects of the injections, such as weakness of the legs, deformity, or abnormal sensation, were observed. There were also no cases of swelling, edema, hematoma, or infection. BTX at both dosages can be safely and effectively applied for calf muscle contouring without disturbing gait during walking or running.

Paralysis of the gastrocnemius medial head differentially affects gait patterns and muscle activity during level and stair ascent locomotion

BackgroundPrior studies have analyzed the activity of the gastrocnemius (GCM) medial and lateral heads as a single unit because it is technically challenging to separately analyze the function of each component in vivo. However, functional variation between the medial and lateral heads is expected due to their anatomical differences. Research questionWhat is the independent function of the medial GCM? How does paralysis of the GCM medial head affect gait kinematics?. MethodsTwelve healthy adults (two males and ten females; age: 28.2 [±7.72] years) that were scheduled to undergo neurolysis of the tibial nerve branch supplying the medial head of the GCM for aesthetic calf reduction participated in the study. Gait analysis was performed using a computerized opto-electric gait analysis system to measure kinematic data. Surface electromyography (EMG) was recorded simultaneously during the gait analysis. Surface electrodes were placed on seven muscles. Pre-procedure and 1-week and 3-month post-procedure data were compared using a linear mixed model. ResultsDuring level walking, decreased activity of the GCM medial head did not significantly change gait kinematics. However, a significant increase in GCM lateral head and hamstring activities occurred after a branch nerve block to the GCM medial head. During stair ascent, in contrast to level walking, changes in EMG activity only occurred in the GCM medial head, and post-procedure ankle dorsiflexion angles at the end of the terminal-stance phase significantly increased. Ankle plantarflexion angles during the push-off phase were also decreased when compared with pre-procedure values. SignificanceThe human body response to dysfunction of the GCM medial head depended on the type of locomotion.

Morphological variants of nerve to gastrocnemius muscle, an anatomical guide to perform surgical dissection

SUMMARY Background. The precise knowledge about distribution of nerves supplying the gastrocnemius muscle is clinically important. The present study aimed to observe the morphological variations in the nerve supply of gastrocnemius in a sample South Indian population. Methods. The study included 38 formalin fixed adult cadaveric lower limbs. Variation in the number and branching pattern of the nerve to gastrocnemius muscle was studied. An imaginary line connecting the medial and lateral epicondyles of the femur, was considered as the reference line to study the topographical origin of the nerves. Results. It was observed that tibial nerve was giving one, two or three branches to the medial head of gastrocnemius muscle in 47.4%, 44.7% and 7.9% cases, respectively. The lateral head of gastrocnemius was receiving single, double or triple branch from tibia nerve in 60.5%, 34.2% and 5% cases, respectively. The nerve that innervated lateral head of gastrocnemius was also supplying soleus in 81.6% cases. The nerve to medial head was found at a higher level than the nerve to lateral head in 27 (71.1%) cases, whereas in 11 (28.9%) cases both were originating at the same level. In 76.3% cases, the nerve to MG was originating above the reference line and in 23.7% cases, below it. The nerve to LG was diverged below the reference line in 84.2% cases, at the reference line in 7.9% cases and above it in 7.9% cases. Conclusion. We report variations in the number and topography of nerves supplying the gastrocnemius muscle, that are enlightening to the operating plastic surgeon during the procedures like triceps surae nerve block and calf reduction. This data can be used as an anatomical guide to perform the surgical dissection

Restoration of calf deformities in a 35-year-old man following 2 calf reduction surgical procedures

Restoration of calf deformities in a 35-year-old man following 2 calf reduction surgical procedures

Simultaneous Use of Selective Neurectomy With Liposuction for Calf Reduction in Asians.

Calf contouring continues to be popular among Northeast Asians. Calf hypertrophy and distorted leg contours are stressful to many women. Several calf reduction techniques such as a selective neurectomy or calf muscle resection have been attempted, but have inconsistent results. This study was designed to demonstrate improved outcomes when combining a selective neurectomy with simultaneous liposuction. A total of 780 patients with hypertrophic calves underwent calf reduction from January 2002 to December 2010. Of these, 193 patients were treated by selective neurectomy with simultaneous liposuction. Calf hypertrophy with a circumference below 34 cm was defined as mild, calves with a circumference of 34 to 38 cm were defined as moderate, and a calf circumference above 38 cm was defined as severe. In all groups, patients whose pinch test was above 2 cm underwent a simultaneous liposuction. Twenty-eight cases (14.5%) were defined as mild, 72 (37.3%) were moderate, and 93 (48.2%) were severe. Over an average of 8.7 months of postoperative follow up, the reduction in calf circumference averaged 3.7 cm in the mild group (11.1%), 4.0 cm in the moderate group (10.7 %), and 4.3 cm in the severe group (10.7%). Overall, 97.5% of patients were satisfied with the results. There were no severe complications including functional problem of lower extremity reported. The shape, type, and fat distribution of the hypertrophic calves were considered in our patient analysis. A selective neurectomy with liposuction was performed on 193 patients. This technique allowed for a successful calf reduction and improved the patient's aesthetic satisfaction without any reported functional complications.

Commentary on: Simultaneous Use of Selective Neurectomy With Liposuction for Calf Reduction in Asians.

Commentary on: Simultaneous Use of Selective Neurectomy With Liposuction for Calf Reduction in Asians.

Anatomical study of the nerve regeneration after selective neurectomy in the rabbit: clinical application for esthetic calf reduction

The purposes of this study were therefore to characterize the degeneration and regeneration of nerves to the calf muscles after selective neurectomy, both macroscopically and microscopically, and to determine the incidence of such regeneration in a rabbit model. Seventy four New Zealand white rabbits were used. Selective neurectomy to the triceps surae muscles was performed, and the muscles were subsequently harvested and weighed 1-4 months postneurectomy. The gastrocnemius muscles were stained with Sihler's solution to enable the macroscopic observation of any nerve regeneration that may have occurred subsequent to neurectomy. The change in triceps surae muscle weight was measured along the time course of the experiment. After neurectomy, nerve degeneration was followed by regeneration in all cases. The weight of the triceps surae muscle decreased dramatically between completion of the neurectomy and 1 month postneurectomy, but increased thereafter. The nerve branches were weakly stained with Sihler's solution until 2 months postneurectomy, and then strongly stained after 3 months. The number of myelinated axons was decreased at 2 month after neurectomy compared to nonneurectomized controls, but then gradually increased thereafter. Although there are currently no reports on the incidence of recovery after calf reduction, it may be a very common occurrence in the clinical field based on our findings. The findings of this study provide fundamental anatomical and surgical information to aid planning and practice in calf-reduction surgery.

Aesthetic Contouring of Calf Hypertrophy with Radiofrequency Volume Reduction

Introduction: Asians tend to have short and thick calves. Therefore, a chubby and muscular shape of the legs is of particular concern. Many methods have been performed frequently for calf contouring. In this study, we describe our experience in percutaneous induction of coagulation necrosis with radiofrequency (RF) energy for the reduction of the volume of gastrocnemius muscles (GCMs). Materials and Methods: A total of 360 patients were enrolled in this study from 2009 to 2013. The operations were performed with the patients in a prone position under both local and intravenous anesthesia. The RF energy was delivered along each treatment line, and the total amount of energy applied to each calf was approximately 9.5 kJ to 13.3 kJ. Results: The average reduction in calf circumference was 1.7 cm (5%), and the average change of GCM thickness was 4.11 mm (20%). The difference between the reduction rates was significant (P = .002), which means the rate of reduction in GCM thickness is significantly higher than that of calf circumference reduction. Conclusions: Calf reduction using RF could be used to treat hypertrophic calf muscles with minor improvement and relatively low risk. However, the reduction rate of calf circumference was significantly lower than that of the GCM thickness. This could be explained by the fact that the improvement could be masked by leg edema associated with daily physical activities and substantial compensatory hypertrophy of the soleus muscle. This fact should be clearly communicated to the patients before RF reduction of the calf.

Severe Equinus Deformity After Radiofrequency-Induced Calf Muscle Reduction

Radiofrequency-induced calf muscle volume reduction is a commonly used method for cosmetic shaping of the lower leg contour. Functional disabilities associated with the use of the radiofrequency (RF) technique, with this procedure targeting the normal gastrocnemius muscle, still have not been reported. However, the authors have experienced several severe ankle equinus cases after RF-induced calf muscle volume reduction. This study retrospectively reviewed 19 calves of 12 patients who showed more than 20° of fixed equinus even though they underwent physical therapy for more than 6months. All were women with a mean age of 32years (range, 23-41years). Of the 12 patients, 7 were bilateral. All the patients received surgical Achilles lengthening for deformity correction. To evaluate the clinical outcome, serial ankle dorsiflexion was measured, and the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the latest follow-up visit. The presence of soleus muscle involvement and an ongoing lesion that might affect the postoperative results of preoperative magnetic resonance imaging (MRI) were investigated. Statistical analysis was conducted to analyze preoperative factors strongly associated with patient clinical outcomes. The mean follow-up period after surgery was 18.6months (range, 12-28months). At the latest follow-up visit, the mean ankle dorsiflexion was 9° (range, 0-20°), and the mean AOFAS score was 87.7 (range, 80-98). On preoperative MRI, 13 calves showed soleus muscle involvement. Seven calves had ongoing lesions. Five of the ongoing lesions were muscle edema, and the remaining two lesions were cystic mass lesions resulting from muscle necrosis. Ankle dorsiflexion and AOFAS scores at the latest follow-up evaluation were insufficient in the ongoing lesions group. Although RF-induced calf muscle reduction is believed to be a safer method than conventional procedures, careful handling is needed because of the side effects that may occur in some instances. The slow progression of fibrosis could be observed after RF-induced calf reduction. Therefore, long-term follow-up evaluation is needed after the procedure. Therapeutic case series.

Anatomic study of selective neurectomy of gastrocnemius muscle for calf reduction in Chinese

Selective neurectomy of the innervating nerves of the gastrocnemius muscle is a popular method employed for calf reduction. However, accidental injury to the untargeted adjacent nerves could happen. This study aims to provide detailed morphometry of the motor branches from the tibial nerve innervating the gastrocnemius muscle, the soleus and the medial sural cutaneous nerve in the popliteal fossa. 23 lower legs from female cadavers were dissected to explore the origin, length of and the spatial relationship between the four branches given off from the tibial nerve in the popliteal fossa. Our study showed there were seven origin patterns existing among the four nerve branches; the origin of the branches to the medial and lateral heads of the gastrocnemius muscle was located ranging from -16mm to 22mm away from the midpoint of the line between the lateral and medial condyles of the femur; In 95% of the specimens, the location of the origin of the nerve branch to the medial head was proximal to its lateral counterpart. The nerve to the medial head was often given off from the medial aspect or the posteromedial aspect of the tibial nerve, while the other three often from the lateral aspect. A variety of origin patterns among the nerves to the lateral and medial gastrocnemius muscle, the nerve to the soleus muscle and the sural cutaneous nerve exist, necessitating the formulation of diversifying surgical strategies preoperatively and the meticulous and sequential dissection intra-operatively to ensure the lowest level of accidental injury.