It affects the entire lower limb and the movement of the hip and the lumbar area. The gastrocnemius muscle flap for reconstruction of the proximal third of lower leg. Gastrocnemius muscle an overview sciencedirect topics. Use of gastrocnemius muscle and musculocutaneous flaps. The gastrocnemius muscle flap is readily available for knee coverage. Gastrocnemius muscle flap is a relatively common procedure in orthopaedic practice for coverage of proximal leg wounds. Pdf the gastrocnemius muscle flap for coverage of soft. With reference to the data reported in the literature and to the anatomical vascular basis, the authors expose different techniques and maneuvers used for dissection of gastrocnemius flaps. Technique, indications, and results of proximal medial. The flap size can be increase by including the skin overlying the muscle. Application of split thickness skin graft stsg over lateral hemisoleus muscle flap. The reach of the gastrocnemius musculocutaneous flap.
The pediculated gastrocnemius muscle flap as a treatment. A muscle flap is indicated when vital structures such as bones, joints, tendons, or hardware are exposed and require coverage. Of all the local rotational flaps, the gastrocnemius. A report of eight cases and description of the technique. A medial gastrocnemius flap was raised distal to its musculotendinous insertion.
Medial gastrocnemius muscle flap robert ostrum, md on vimeo join. Medial gastrocnemius flap in the course of treatment for an. The area of coverage and the reach of the flap will increase the main problem with this flap gastrocnemius musculocutaneous flap is the donor site morbidity because the expose. Nikhil panse, rahul bhadgale, ankur karanjkar, rohit phulwer, parag sahasrabudhe, chaitanya ramteke abstract background dvwurfqhplxv pxvfoh dqg pxvfxorfxwdqhrxv adsv duh yhu\ yhuvdwlohdqgrqhriwkhfrpprqo\xvhgadsviruorzhuhwuhplw\. Pdf on aug 1, 2015, ali karbalaeikhani and others published gastrocnemius muscle flap and its application in lower extremity. Muscle flaps, fasciocutaneous flaps, and free tissue transfer are useful for knee coverage. Gastrocnemius compartment syndrome the gastrocnemius muscle is made up of two heads. Once the muscle flap has been mobilized proximally, a. In the lower leg and particularly the tibia, a muscle flap must be well vascularized and durable. Through knee amputation with gastrocnemius musculocutaneous flap 6 cases of tibial osteosarcoma followed for 3 1 6 years g h robert albers, jan w v d eijken3 and johannus bras2 6 cases of proximal tibial osteosarcoma were oper only complication was one wound dehiscence which ated on by through knee amputation using a long healed. Role of the medial gastrocnemius muscle flap in soft tissue defect reconstruction of the leg in children.
Outcome of islanded gastrocnemius musculocutaneous flap in. The larger and medial head arises from the medial condyle of the femur, and the lateral smaller head arises from the lateral condyle. Gastrocnemius muscle flap can only cover small wound in the proximal tibia. The use of muscular and myocutaneous gastrocnemius flaps and some modifications of the standard surgical technique aiming to gain more versatility are described. Transection of the lateral hemigastrocnemius is per formed by maintaining a vascularized pedicle proximally containing the sural artery figure 8.
It is, however, most suitable for the lower knee region. The medial gastroc flap may be harvested via posterior fig. This technique may also not be ideal in elderly or very thin patients who may have smaller gastrocnemius muscle bellies. Indications the gastrocnemius muscle is routinely used for soft tissue loss and bone coverage over the proximal onethird of the tibia. Gastrocnemius flaps can be easily harvested with a planned skin paddle designed over the chosen muscle. Gastrocnemius is a large muscle located in the posterior leg. Soleus muscle flap application for reconstruction of the. Vascularization is assured by vascular anastomoses between the two muscles crossing the midline. For the proximal third of the tibia, the gastrocnemius muscle flap is the best choice.
The deltoid muscle is a rounded, triangular muscle located on the uppermost part of the arm and the top of the shoulder. The deltoid is attached by tendons to the skeleton at the clavicle collarbone, scapula shoulder blade, and humerus upper arm bone. However, about functional loss for higher loads especially in sports activities is reported in the literature. The gastrocnemius muscle flap is one option for coverage. Lateral gastrocnemius myocutaneous flap transposition to. Pdf gastrocnemius muscle flap and its application in lower. We describe a case of extensor reconstruction using an extended medial gastrocnemius myocutaneous flap. This video demonstrates a medial gastrocnemius rotation flap for soft tissue coverage of the proximal tibia. If you continue browsing the site, you agree to the use of cookies on this website. For the middle tibia, the soleus flap is used, and distal to that a free flap is needed either the medial or lateral heads of the gastrocnemius can be used, though the proximity to the peroneal nerve and its shorter length make the lateral less desirable. Medial gastrocnemius flap in the course of treatment for. The gastrocnemius muscle lies in the upper posterior lower leg and forms the superficial bulge of the calf. When the defect is so large as to require more than just the soleus and medial gastrocnemius flaps, a free flap should strongly be considered as a means of soft tissue coverage and. The medial head originates on the posterior surface of the femur superior to the medial condyle and posterior to the insertion of the adductor magnus muscle.
Anatomy of the gastrocnemius muscle everything you need to know dr. Use of local muscle flaps to cover leg bone exposures discussion the treatment of skin loss resulting from traumatic, infectious and vascular ulcerations processes is a challenge for surgeons and often requires the assistance of specialized techniques of plastic surgery and microsurgery. Because the gastrocnemius is a type i proximally based muscle flap, it is important to maintain the main perforator to vascularize the distal aspect of the flap 29. Both lateral and medial gastrocnemius flaps are used as a muscle or myocutaneous flap to cover defects surrounding the knee, lower thigh, patellar region and upper third of tibia. Thegastrocnemius myocutaneous flap hasbeen described comprehensively bymccraw, dibbell and carraway 1977, mccraw, fishman and sharzer 1978 and feldman, cohen andmay 1978. Pedicle muscle flap coverage as an adjunct to internal. The gastrocnemius muscle is versatile in flap repair of defects from anterior knee to lower leg. From a planning perspective the medial gastrocnemius muscle is about the same size as the ulna half of the patients hand, being roughly 15cm long and 7cm wide in the average adult figure 3. Muscle flaps medial gastrocnemius, lateral gastrocnemius. There are two bellies to the muscle and these are separated by the sural nerve figure 2. Gastrocnemius muscle belly a from the medial soleus muscle belly b, using the aponeurosis c as the landmark to separate. Sural flaps can reconstruct the distal third of the tibia, for example. This simple technique combines the advantages of muscular and fasciocutaneous flaps for knee joint area coverage. An attempt is made to refine the technique of flap.
Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. An introduction to lower limb muscle flaps and reconstruction. The gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg article pdf available february 2017 with 288 reads how we measure reads. Its consistent vascular anatomy and superficial location have made it a workhorse for coverage of defects in this area. The proximally based lateral superficial sural artery flap. Separate branches for the medial and lateral gastrocnemius muscles, via the posterior tibial nerve. Medial gastrocnemius muscle flap robert ostrum, md on vimeo. Gastrocnemius muscle and musculocutaneous flaps are very. Gastrocnemius myocutaneous flaps for knee joint coverage. Knee extensor mechanism reconstruction with an extended. Atlas of muscle and musculocutaneous flaps globalhelp publication. When gastrocnemius muscle flap techniques have already been used and. Medial gastrocnemius flap for reconstruction of the.
Covered successfully with a gastrocnemius muscle flap. About europe pmc funders joining europe pmc governance roadmap outreach. Gastrocnemius rotation flap technique orthopaedicsone. A muscle flap was indicated not only to provide durable soft tissue coverage and an optimal graft site, but for its recognized beneficial effect in contaminated wounds, ie, coverage by fresh tissue and a renewed blood supply. The pedicled soleus muscle flap for coverage of the middle.
The use of muscular and myocutaneous gastrocnemius flaps and. Various flaps comprising of skin and muscles around the joint have been. It takes its name from the greek words gaster meaning stomach or belly, and kneme meaning leg. The medial gastrocnemius muscle flap was chosen for several reasons. The gastrocnemius muscle is a complex muscle that is fundamental for walking and posture. Outcome of islanded gastrocnemius musculocutaneous flap. Distally based lateral hemisoleus muscle flap for osseous and. The gastrocnemius muscle is routinely used for soft tissue loss and bone coverage over the proximal onethird of the tibia. Distally, sharply detach the tendinous portion of the medial gastrocnemius muscle from its aponeurosis, beginning at the medial edge and extending to the median raphe, leaving an approximately 1cm cuff of achilles tendon attached to the flap fig. This is due to secure soft tissue coverage of possibly exposed bone and prosthetic material.
Use of gastrocnemius muscle and musculocutaneous flaps for. Anatomical study of the medial gastrocnemius muscle flap. Since that time, the proximal gastrocnemius release has become less invasive and has evolved to include only the fascia overlying the medial head of the gastrocnemius muscle. Flaps that use the lateral gastrocnemius are typically used alone or in combination with the medial gastrocnemius for coverage of defects of the upper tibia, the knee joint, and the popliteal fossa. Gastrocnemius medial flaps, interactive surgery 10. This flap is probably one of the safest flaps, and relatively easy to dissect. Gastrocnemius lateral 10% to 30% of individuals have a. Although the width and reach of the flap can be increased by scoring its fascia or. Gastrocnemius rotation flap orthopaedicsone articles.
Use of local muscle flaps to cover leg bone exposures. An in vitro biomechanical study comparing the spiral linking technique. Pdf anatomy, bony pelvis and lower limb, gastrocnemius. The indications for performing this procedure are a clinically demonstrable gastrocnemius contracture that influences a variety of clinical conditions in the forefoot. The muscle, located in the superficial posterior compartment of the leg, is usually spared during injury. The pedicled gastrocnemius muscle flap has been appreciated for its reliable blood supply, easy harvest, and feasible arc of rotation, making it a widely used flap to cover defects in the distal. Endoscopic harvest of the medial gastrocnemius muscle flap.
Posteriorly, is the most superficial of the muscles of the leg, and forms the bulk of the calf. The medial gastrocnemius was denervated after identifying the neurovascular bundle proximally, taking care to preserve the sural arterial pedicle. It is named after the greek letter delta, which is shaped like an equilateral triangle. Microsurgery can augment medial gastroc use as a local flap by extending the reach of the muscle. Knee reconstruction with prosthesis and muscle flap after. The lateral head originates in the lateral epicondyle of the femur. Proceed with dissection of the muscle flap from distal to proximal. The soleus can be used in conjunction with the medial or lateral gastrocnemius muscles for larger defects spanning the upper aspect of the lower leg, but this will compromise remaining plantar flexion. The gastrocnemius muscle flap for reconstruction of the. The gastrocnemius with soleus bimuscle flap journal of plastic. Medial gastrocnemius muscle flap in limbsparing surgery of malignant bone tumors of. For the middle tibia, the soleus flap is used, and distal to that a free flap is needed.