Gastrocnemius Myocutaneous Flap Research Articles

Modified medial gastrocnemius myocutaneous flap with extended anterior, inferior and/or posterior boundaries: Anatomical observation and report of a clinical series of 33 flaps

IntroductionReports on medial gastrocnemius myocutaneous (MGM) flaps with extended inferior and posterior boundaries are rare, and information about the MGM flaps with extended anterior boundaries is unavailable. Thus, this study aimed to investigate the vascular anatomical basis and clinical reliability of the modified MGM flap with extended anterior, inferior and/or posterior boundaries. MethodsFive fresh lower limb specimens from patients with recurrent tumours in the thigh were immediately irrigated and perfused. The stripped integuments were radiographed. The pretibial skin was equally divided into nine zones. The reconstruction outcomes of the modified MGM flaps were documented in 33 patients. ResultsTrue anastomotic connections existed among the branches of the saphenous artery, the perforator from the inferior medial genicular artery and 3–5 (mean, 4.5) perforators from the posterior tibial artery in the upper two-thirds of the leg. A total of 33 modified MGM flaps were applied. The anterior margins of 26 modified flaps with extended anterior boundaries exceeded the medial edge of the tibia by 1.0–4.5 cm (mean, 2.1 cm). Fourteen modified MGM flaps were used to repair the defects involving the lower third leg, whose distal edges were located in the seventh (n = 8) or eighth (n = 6) zone. A 1–169-month (median, 9 months) follow-up was conducted for 33 patients. Of the 33 flaps, 29 (87.9 %) survived completely, partial necrosis occurred in four flaps with extended anterior (n = 2) or inferior (n = 2) boundaries. ConclusionsMultiple source vessels are the vascular anatomical basis of the modified MGM flap with extended anterior, posterior and/or inferior boundaries. The modification of the MGM flap is feasible and reliable, broadening the applicable scope of the flap. The modified MGM flap can be applied to repair more distal, wider and larger-area defects with a simpler design and procedure.

THE ROLE OF GASTROCNEMIUS MYOCUTANEOUS FLAP IN COVERING DEFECTS OF PROXIMAL AND MIDDLE THIRD OF LEG

BACKGROUND: The treatment of a large soft tissue defect affecting the upper and middle portion of the leg remains a problem. The purpose of this study was to determine the efficacy and adaptability of a gastrocnemius myocutaneous flap cover for a post-traumatic major defect of the upper and middle third of the leg. METHODS: This prospective study was undertaken from January 2021 to December 2022 on 27 consecutive cases with post-traumatic upper and middle third leg defect treated with gastrocnemius myocutaneous flap, and the functional and aesthetic outcomes were assessed. RESULTS: There were no reports of full flap failure. In two individuals (7.4%), there was partial cutaneous necrosis and infection noted in one individual (3.7%) There was no postoperative hematoma. In terms of donor site morbidity, no functional deformity was seen during the follow-up period. The process was proven to be dependable, technically simple, and visually pleasing. CONCLUSION: Post-traumatic extensive leg defects extending in the upper and middle thirds were easily covered with a regional gastrocnemius myocutaneous flap, resulting in a great outcome and cosmetically acceptable skin coverage without substantial problems or long-term morbidity and can be performed by an orthopedic surgeon without the assistance of plastic surgeon

Perforator anastomosis of the sural artery system and its application in extended gastrocnemius flap

IntroductionThe conventional management for long defects involving the middle one third of leg with exposed bone is cover by a combination of soleus with fasciocutaneous or gastrocnemius flap. To decrease operative time, donor site morbidity and complexity of surgery we offer a simpler flap where the territory of the gastrocnemius myocutaneous flap can be extended by including the septocutaneous perforators in the leg. Material & MethodsThe vascular basis of the flap was determined by studying Digital Subtraction Angiography(DSA) images of lower limbs of 10 patients who had undergone the procedure for pathology in systems other than the lower limb.Following this study, we operated 18 cases over 2 years. All cases were of post-traumatic defects of middle and proximal part of lower third of leg that were treated with extended gastrocnemius myocutaneous flap in department of plastic surgery. The length of defect, length of flap used, means operative time and flap complications in the post op Period would be recorded. ResultsThe DSA study revealed various perforator anastomosis between the distal branch of the sural with the posterior tibial and peroneal system. Of these a grade 2- grade 2 perforator anastomosis was most common.On evaluation of the 18 patients of Gustillo Type 3b fracture that were covered with the extended flap, we found the mean operative time for the procedure to be 86 min (range 68–108 min). The average length of defect covered was 9.7 cm and the average dimension of flap was 23.09 cm in length and 7.9 cm in breadth. In the postoperative period no patient has a flap failure of necrosis of the distal stich line. ConclusionThis extended gastrocnemius myocutaneous flap is a good option to tackle long defects overlying the middle and lower thirds of tibia. It offers a much simpler and faster alternative to using two flaps in combination. The vascular basis of the flap appears sound as there is usually a grade 2-grade 2 perforator anastomosis between the sural system with the posterior tibial and peroneal systems.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

Clinical study of upper one third leg defects

Large soft tissue leg defect involving upper and middle third remains a therapeutic challenge. Clinical study of management of upper one third defects was done to analyze the various reconstructive procedures for leg defects and also to enhance the quality of work done to produce good results with minimal complications as possible. This Prospective Clinical study conducted in the department of Plastic and Reconstructive surgery, includes 20 cases of upper one third of leg defects admitted. Patients >15years of age with Soft-tissue defects of upper one third leg requiring flap cover are included in this study. The operative procedure was chosen according to the nature and size of the defect. The earliest flap cover was given within 1 week of trauma. Primary flap cover was given in 10 (50%)patients, delayed primary flap cover in 9 (45%) patients and secondary flap cover in 1 (5%) patient. In 14 (70%) patients Gastrocnemius flaps were done, of which Gastrocnemius muscle flaps with SSG were done in 9 patients (45%) and Gastrocnemius Myocutaneous flap in 5 patients (25%). Fasciocutaneous Flaps in 4 patients (20%), Venous flap in one patient (5%) and Advancement Flap in 1 patient (5%) were done.

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

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.

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Modified Medial Gastrocnemius Myocutaneous Flap Technique for Knee Joint Coverage after Total Knee Arthroplasty

While there are many reasons the medial gastrocnemius flap is often the favored treatment for soft tissue defects around the knee area, this flap has some disadvantages. Reduced volume at the distal part of the flap and a short reach complicate provision of sufficient coverage for soft tissue defects superior to the patella and the lateral knee. In order to overcome these shortcomings, we modified the typical surgical technique by combining a medial gastrocnemius muscle flap and a medial sural artery perforator flap. This approach was applied to four patients who had developed deep infections and skin and soft tissue defects around the knee joint after total knee arthroplasty. The surgeries were successful. Dead space was well-filled and wounds healed without complications in all patients. This modified medial gastrocnemius myocutaneous flap provides a new option for treating challenging skin and soft tissue defects caused by deep infection after total knee arthroplasty.

Letter to the Editor Following "Lateral Gastrocnemius Myocutaneous Flap Transposition to the Midlateral Femur Extending the Arc of Rotation" by Agarwal et al.

Letter to the Editor Following "Lateral Gastrocnemius Myocutaneous Flap Transposition to the Midlateral Femur Extending the Arc of Rotation" by Agarwal et al.

Clinical application of anterolateral thigh flap in wound around the knee with descending genicular artery as the recipient vessel

Objective To explore the clinical application of anterolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel, when anterior or posterior tibial vessel could not be utilized. Methods From January, 2015 to May, 2017, free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients, after preoperative color Doppler sonography ultrasound (CDU) for precise positioning. There were 4 males and 3 females, with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm. All of the donor sites were sutured directly. Postoperative followed-up was done termly. Results All the patients were followed-up for 6 to 14 months, with an average of 8.9 months. Typically, 2 cases had large defect areas, with distal flap necrosis of 6.0 cm and 4.0 cm, respectively, which were resected and achieved secondary skin graft healing on the residual surface. Additionally, 4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface. The remaining 1 case had completely survived flap, but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis. As a result, the patient received gastrocnemius myocutaneous flap to repair the wound. Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee, with descending genicular artery as the recipient vessel, can achieve satisfactory clinical efficacy, which can serve as one choice for flap repair in wound around the knee. Key words: Anterolateral thigh flap; Descending genicular artery; Knee joint; Transplantation

Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect of Upper and Middle Third Leg.

BACKGROUNDLarge soft tissue leg defect involving upper and middle third remains a therapeutic challenge. The objective of this study was to evaluate the effectiveness and versatility gastrocnemius myocutaneous flap cover for post traumatic large defect of upper and middle third of leg.METHODSThis prospective study was conducted from January 2015 to January 2017 on 25 consecutive cases of post-traumatic upper and middle third leg defect who were treated with gastrocnemius myocutaneous flap and the functional and aesthetic outcome were evaluated.RESULTSThere was no case of complete flap failure. Partial skin necrosis occurred in 2 patients (8%). There was no postoperative hematoma while mild discharge was seen in only 4(16%) patients. With regard to the donor site morbidity, no functional deformity was seen in follow up period. The procedure was found to be reliable, technically easy and aesthetically acceptable.CONCLUSIONPost-traumatic large defects of leg extending in upper and middle third were easily covered with the help of regional gastrocnemius myocutaneous flap with excellent outcome and aesthetically acceptable coverage of skin without any major complications or long term morbidity.

Coverage of Giant Sacral Sore With a Gastrocnemius Myocutaneous Flap Pedicled With Femoral Vessels After Thigh Amputation

The purpose of this report was to present the results of coverage of giant sacral sores with a gastrocnemius myocutaneous flap pedicled with femoral vessels after thigh amputation. Between June 1989 and April 2010, 10 patients with paraplegia having giant sacral pressure sores underwent early aggressive surgical debridement followed by surgical reconstruction with a gastrocnemius myocutaneous flap pedicled with femoral vessels after thigh amputation. The spinal cord injury was secondary to trauma in 8 patients and non-traumatic in 2 patients. The wounds measured between 8 cm × 26 cm and 26 cm × 30 cm. The post-operative course was uneventful in 8 patients. Partial flap necrosis occurred in 2 patients who were treated with skin grafts. The follow-up period ranged from 12 to 96 months. There was no recurrence of the sore in any patient. This technique may be a treatment option for the repair of huge sacral bedsores in the absence of other reliable methods for patients with paraplegia.

Medial sural artery perforator flap in head and neck reconstruction

Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.

Tissue flap repair strategy for severe defects of skin and soft tissue around the knee joints

To explore selection and method of tissue flaps for the repair of severe defects of skin and soft tissue around the knee joints. Fifty-four patients with wounds around the knee joints, all accompanied by exposure or necrosis of tendon or bone and exposure of prosthesis, were hospitalized in our burn center from June 2008 to December 2014. Five of them were with knee joint injury. After thorough debridement or tumor resection, the wound area ranged from 5 cm × 5 cm to 46 cm × 22 cm. Three patients were repaired with free latissimus dorsi myocutaneous flaps, 7 were repaired with modified sartorius myocutaneous flaps, 8 were repaired with gastrocnemius myocutaneous flaps, one was repaired with gastrocnemius muscle flap, two were repaired with posterior leg flaps combined with gastrocnemius muscle flaps, one was repaired with femoral biceps muscle flap combined with gastrocnemius muscle flap, 13 were repaired with reverse anterolateral thigh island flaps, two were repaired with reverse anterolateral thigh island flap combined with gastrocnemius myocutaneous flaps, two were repaired with superior lateral genicular flaps, 4 were repaired with reverse posterior thigh island flaps, 11 were repaired with saphenous artery flaps. Patellar ligament was reconstructed in 4 patients. The tissue flap size ranged from 5 cm × 5 cm to 38 cm × 19 cm. Some donor sites were sutured directly, and the others were closed by split-thickness skin grafting obtained from ipsilateral or contralateral legs. Among 59 tissue flaps of 54 patients, 55 tissue flaps of 50 patients survived, while necrosis of the distal part was observed in 4 tissue flaps, including one saphenous artery flap, two reverse anterolateral thigh island flaps, and one free latissimus dorsi myocutaneous flap. Among them, 3 flaps with necrosis at the distal part healed after debridement followed by skin grafting, one myocutaneous flap healed by transplanting gastrocnemius myocutaneous flap. During the follow-up period of 6 to 36 months, the tissue flaps were in good appearance and texture, and knee joint function was good in most cases. In 4 patients the knee joint function was satisfactory after patellar ligament reconstruction, while stiffness was observed in 4 out of 5 patients with knee joint injury. Free latissimus dorsi myocutaneous flaps are preferred to repair extensive defects around the knee joints. Reverse anterolateral thigh island flaps followed by saphenous artery flaps are preferred to repair wounds around the anterior knee. Wounds of the lateral knee are mainly repaired with reverse anterolateral thigh island flaps, and for small wounds the use of the superior lateral genicular flaps may be considered. Wounds of the medial knee can be repaired with modified sartorius myocutaneous flaps or saphenous artery flaps. Wounds of the posterior knee can be repaired with reverse posterior thigh island flaps or superior lateral genicular flaps. Wounds with severe infection or large space can be repaired with gastrocnemius myocutaneous flaps or muscle flaps or modified sartorius myocutaneous flaps. Anterolateral thigh flaps and gastrocnemius myocutaneous flaps are preferred in cases with indication of patellar ligament reconstruction.

Evaluation of the versatility of superiorly based pedicled gastrocnemius myo- or myo-cutaneous flap, in upper leg defects after trauma or tumor excision: which is better?

Purposes The current study aimed to focus on the versatility of the superiorly based pedicled gastrocnemius muscle flap or myocutaneous flap, either medial or lateral head, in upper-leg defects after trauma or tumor excision and the importance of these flaps to improve bone healing in trauma and to ensure an adequate safety margin in malignant tumors with minimal complications. Patients and methods A prospective, randomized trial was conducted on 27 patients suffering from upper-leg defects after trauma or tumor excision to compare postoperative outcomes, especially bone healing, using superiorly based pedicled gastrocnemius muscle flap covered by a split thierch skin graft [group A; 14 (51.8%)] against myocutaneous flap [group B, 13 (48.2%) cases], either medial or lateral head. Postoperative follow-up was for 6 months. Results Rapid healing of the tibial fracture was noticed in 8 (57.1%) cases in group A and in 8 (61.5%) cases in group B within 2 weeks after surgery, and there was no flap loss apart from partial skin loss, minor hematomas, or infections, all were noticed significantly more in group A [5 (35.7%), 6 (42.9%), and 4 (28.6%) cases, respectively], compared with group B [1 (8%), 2 (15.4%), and 1 (8%) cases, respectively; P < 0.05]. Conclusion Both gastrocnemius myocutaneous and myocutaneous flaps for upper-leg reconstruction are considered as a reliable option to ensure a good safety margin in malignant tumor cases and to help bone healing in trauma cases, and myocutaneous flaps are safer, with no redo and lesser postoperative complications.

Lateral Gastrocnemius Myocutaneous Flap Transposition to the Midlateral Femur

We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.

Management of a Massive Stage IV Sacral Decubitus Ulcer With Anterior Flap Hip Disarticulation and Myocutaneous Gastrocnemius Fillet Flap In-Continuity

Severe sacral decubitus ulcers represent a common and often recalcitrant clinical problem in paralyzed or bedridden patients and require treatment strategies ranging from specialty beds and local wound care to aggressive debridement and local or free tissue flap coverage. This article presents the case of a young soldier who sustained severe injuries as a result of an improvised explosive device blast, including bilateral sciatic nerve injuries, sacrogluteal degloving, and severe left acetabular and femoral head fractures. The patient subsequently developed a recalcitrant stage IV sacral decubitus ulcer, left acetabular protrusio with minimal left lower extremity function, and ankylosis of the posterior right hip due to heterotopic ossification. A novel left anterior (quadriceps-based) hip disarticulation was performed with a double gastrocnemius myocutaneous fillet flap in-continuity. The procedure was successful in providing robust, partially sensate soft tissue coverage for the decubitus ulcer, permitting removal of the bridging posterior heterotopic ossification of the right hip, and removing the left hip for which reconstructive options were limited due to the absence of superior and inferior gluteal nerve function. The patient healed uneventfully and was subsequently able to resume unrestricted positioning for sitting and wheelchair mobilization and became a limited ambulator with a hip disarticulation prosthesis and contralateral ankle-foot orthosis.

Exophytic growth of a neglected giant subcutaneous Leiomyosarcoma of the lower extremity. A case report

BackgroundSuperficial leiomyosarcoma is an exceedingly uncommon malignant tumor which could be located either to cutaneous or subcutaneous tissues. Increased mass size and depth, advanced tumor staging and inadequate surgical excision are the main prognostic factors for poor result.Case presentationWe report a rare case of a 71-year-old man with an extensive exophytic lesion (12 × 10 cm) in the anterior-medial side of the proximal right tibia. The lesion was painless and consistently neglected by the patient until a skin trauma caused ulceration of the affected area. Magnetic Resonance Imaging revealed a soft-tissue mass which was well defined from the surrounding bone and muscles. As initial biopsy in another hospital hadn't clarified the true nature of the lesion, new samples were taken and the diagnosis of leiomyosarcoma was established. Laboratory examination showed no distant metastasis and wide excision of the neoplasm was decided. After tumor resection, the remaining soft tissue and skin defect was covered with a gastrocnemius myocutaneous flap. The postoperative period was uneventful and wound healing was followed by local radiotherapy and systemic chemotherapy. At 3 years follow up, no recurrence or metastasis was identified and the patient was able to walk and stand without impairment of his ambulatory status.ConclusionProper surgical management of soft tissue leiomyosarcoma continues to remain the cornerstone of treatment efficacy and the most important prognostic factor for patients' survival. Reconstruction of the remaining soft tissue defect should be always performed at the same operative time when removal of giant size tumors leaves an uncovered cavity with an inadequate sleeve of muscular and skin tissues.

Functional reconstruction of traumatic loss of flexors in forearm with gastrocnemius myocutaneous flap transfer

Reconstruction of flexor function of forearm remains a challenge in the reconstructive surgery. With development of microsurgical techniques, reconstructive surgeons have been able to envision muscle transplantation for restoration of function and not simply for provision of soft tissue coverage. In this report, we present our experience in three patients of successful treatment of traumatic flexor loss in the forearm with the microsurgical medial gastrocnemius myocutaneous flap. At 18- to 24-months follow-up, the detected action potential (Latency and Amplity) in the transferred muscle was significantly improved in the EMG examination. The strength of the digital flexion reached to III degree in one case, IV degree in two cases. No complications were noted in the donor legs. We conclude that the microsurgical medial gastrocnemius myocutaneous flap transfer can be an ideal alternative for functional reconstruction of the forearm flexor muscle in three posttrauma patients.

The bi-pedicled gastrocnemius myocutaneous flap: its anatomic basis and clinical application

目的 为双蒂腓肠肌皮瓣修复小腿远端跟腱及皮肤缺损和术前判断肌皮瓣能修复的范围提供解剖学理论依据.方法 30侧下肢尸体标本,模拟手术时腓肠肌皮瓣的切取,观察肌皮瓣在不同膝关节屈曲时能向下滑动的距离.1993年8月～2005年4月收治12例小腿远端跟腱及皮肤同时缺损患者,小腿远端及跟腱同时缺损面积6 cm×4 cm～10 cm×6 cm,均采用双蒂腓肠肌皮瓣V-Y推进下移修复跟腱及皮肤缺损.结果 不切断腓肠肌起点,膝关节伸直0°时肌皮瓣滑动距离为(1.4±0.4)cm,屈膝90°为(3.3±0.4)cm;Z字切断腓肠肌起点,膝关节伸直0°时滑动距离为(3.7±0.5)cm,屈膝30°为(4 9±0.7)cm,屈膝60°为(6.7±0.7)cm,屈膝90°为(9.2±0.9)cm.临床应用治疗的12例患者均获得4个月～12年随访,皮瓣全部成活,行走功能恢复,踝关节活动度为背伸11.0°±1.4°,跖屈35.0°±4.6°.结论 双蒂腓肠肌皮瓣适合于修复跟腱及皮肤同时缺损。