The muscle flap was superficially dissected and the common peroneal nerve was identified proximal to the muscle flap, allowing for proximal and distal control. In this book, chapters are based not on the flap but the injury site. Muscle herniation in the extremities is a rare clinical entity. Latissimus dorsi type v elevation standard muscle flap posterior axillary incision 510cm pedicle in posterior axilla deep to muscle. This classic muscle flap is now being used with increasing frequency following revision knee joint surgery. The flap is marked on the skin in the form of an ellipse centered on the raphe between the two gastrocnemius muscle bodies, whose projection is visible on the posterior aspect of.
More commonly, this is being achieved with a combination of neoadjuvant radiotherapy, followed by wide excision and soft tissue reconstruction in the form of vascularised soft tissue transfer. Rbcp effect of medial hemisoleus muscle flap on wound. The relatively new medial sural artery perforator flap is increasingly being used for reconstruction. The gastrocnemius muscle flap is one option for coverage. The gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg. Medial gastrocnemius muscle flap for the reconstruction of. Soleus muscle flap application for reconstruction of the. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. In our case series, good functional outcomes of the knee joint were achieved with reattachment of the biceps femoris tendon and lcl and an intact gastrocnemius muscle fig.
The gastrocnemius muscle is separated from the medial portion of the soleus muscle by blunt dissection 20, the deep fascia is opened, and the soleus border is detached from the tibia with the scalpel. Fifth sicotsirot annual internatinal conference, 29 august 1 september 2007, marrakech, morocco. We present two cases of msap flap reconstruction that developed this early complication. For these reasons, the reverse anterolateral thigh alt has become a popular choice in the reconstruction of knee and occasionally proximal tibial defects due to its. Pedicled gastrocnemius flap in complicated total knee.
Several local options exist for the reconstruction of defects around the knee joint 14. Because many existing books focus on only the type of flap, it is difficult for doctors to distinguish which flap is best for their patients in need of reconstructive surgery. Separate branches for the medial and lateral gastrocnemius muscles, via the posterior tibial nerve. The use of gastrocnemius muscle flap in trauma iium. The medial sural artery flap is a type a fasciocutaneous flap based on the sural artery, a direct cutaneous branch of the popliteal artery. Distally based lateral hemisoleus muscle flap for osseous. However, muscle necrosis of the medial head of gastrocnemius after msap flap harvest is a previously unnoticed early complication of the donor site. Continue the dissection in distal area until pivot pint of pedicle.
Simultaneous anterolateral thigh flap and temporalis. Anatomy of the soleus muscle everything you need to know. The results of injection studies in cadavers and in vivo flap construction suggested that a flap based on the medial or lateral gastrocnemius muscle and the skin of the popliteal fossa draining to the long or short saphenous systems respectively provides a good length to breadth ratio flap without prior delay. Split median superficial sural artery perforator mssap. 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 soleus muscle raphe doesnt take the skin graft very well.
Considerations surrounding reconstruction after resection. Posterior approach via a midline incision for harvest of a medial gastrocnemius muscle flap. 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. Muscle flaps, fasciocutaneous flaps, and free tissue transfer are useful for knee coverage. Gastrocnemius musculotendinous flap for reconstruction of. Read intermittent occlusion of the popliteal vein by a gastrocnemius rotational muscle flap. Reverse sural flap for ankle and heel soft tissues. For the proximal third of the tibia, the gastrocnemius muscle flap is the best choice. After debridement of the wound site, the medial head of the gastrocnemius muscle was dissected at the distal aponeurotic region, and elevated.
The aim of our study is to describe our experience with medial gastrocnemius muscle flap coverage following a transtibial amputation. Sural flaps can reconstruct the distal third of the tibia, for example. More recently, the medial sural artery perforator msap flap has been described for such defects, although may necessitate skin grafting of the donor site. At midcalf, identified superficial sural artery, sural nerve, and lesser saphenous vein, performing ligated and included in the flap. Coverage of giant sacral sore with a gastrocnemius. The gastrocnemius muscle flap in the correction of severe flexion contracture of the knee. A proximally based sural fasciocutaneous flap for the. Most commonly, it occurs as a result of an acquired fascial defect, i. For flap dissection, the patient is positioned in the prone position. The medial sural artery perforator msap flap is based on musculocutaneous perforators of the medial gastrocnemius muscle. The distal hemiachilles tendon was sutured to the remnant.
The flap is well described for reconstruction for soft tissue defect as either a free graft or local flap in the upper of the tibia. A report of two cases, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Rbcp versatility of the medial gastrocnemius muscle flap. Treatment of gastrocnemius muscle hypertrophy with. A perforator within this region is routinely present. Delayed compression of the common peroneal nerve following. A majority of soleus muscle fibers originate from each side of the anterior aponeurosis, attached to the tibia and fibula. Mohd yusof, nazri and mohd kasim, kamil and khalid, kamarul ariffin and che ahmad, aminudin and mohd amin, azril 2007 the use of gastrocnemius muscle flap in trauma. Another method of reconstruction of the damaged soft tissue was used on the right knee the gastrocnemius muscle flap.
The gastrocnemius muscle belly was transposed posteriorly and the soleus. Technique, indications, and results of proximal medial. For the middle third, the soleus muscle flap is a good option, being frequently used 2, 7, 8. This procedure again uses a flap of gastrocnemius muscle but with the creation of anteromedial and posterolateral fasciocutaneous flaps based on the cutaneous blood supply of the lower limb. The radiating pain was significantly reduced at 1month postoperation. The doppler probe is most useful in identifying the perforators. Ebraheims educational animated video describes the anatomy of the soleus muscle. The soleus is a muscle located beneath the gastrocnemius muscle in the superficial posterior compartment of. After that transposed flap to the recipient area in. Primary cover of the large popliteal skin defect is achieved by a gastrocnemius versatile muscle flap, which is itself covered by a free split skin graft.
In the each chapter, pitfalls and candidate flaps are described for the reconstruction of each site. The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage has been the main goal. It runs from its two heads just above the knee to the heel, a three joint muscle knee, ankle and subtalar joints. The gastrocnemius muscle flap is often insufficient in volume and arc of rotation for coverage of a large soft tissue defect of the knee and the upper third of the leg. Wrapping the released common peroneal nerve with a proximally based sural fasciocutaneous flap is a useful option for the treatment of recurrent, common peroneal neuropathy. Malignant soft tissue tumor, wide excision, and sural flap. The use of muscular and myocutaneous gastrocnemius flaps and some modifications of the standard surgical technique aiming to gain more versatility are described.
Intraoperative electrical stimulation revealed contraction of the gastrocnemius muscle and further tightening of the fascial band overlying the common peroneal nerve. A gastrocnemius musculocutaneous flap sciencedirect. Lateral distal thigh island flap and medial head gastrocnemius flap methods. The conventional gastrocnemius muscle flap was previously not suitable for tissue defects in the central region of the lower leg, but the inferiorly based gastrocnemius muscle flap could be applied because of the presence of its pedicle on the distal side. A medial gastrocnemius muscle flap was elevated as an island flap based on the medial sural artery. This method can be recommended as the best way to cover the leg and knee. The patient chose an aggressive surgical debridement followed by a flapbased surgical reconstruction. The gastrocnemius muscle flap combined with a splitthickness skin graft remains a consistent and reliable reconstructive option for this area. A pragmatic evaluation of the role of the medial sural. The gastrocnemius muscle flap for reconstruction of the proximal third of lower leg. Vascularization is assured by the medial and lateral sural artery, respectively.
The gastrocnemius muscle flap is readily available for knee coverage. The exposed patella was associated with flexion contracture. Pdf pedicled gastrocnemius flap in complicated total. Of those patients, only patients undergoing simultaneous free flap and ottt at the time of primary tumor extirpation were included. Microsurgery can augment medial gastroc use as a local flap by extending the reach of the muscle. Following the nahai and mathes classification, the gastrocnemius muscle is a type i muscle with a single dominant vascular pedicle figure 1. The gastrocnemius muscle flap in the correction of severe. Report of three cases of reconstruction of skin defects of. The gastrocnemius muscle lies in the upper posterior lower leg and forms the superficial bulge of the calf. In selected patients, with precise ligament and softtissue suturing, the gastrocnemius flap procedure is not mandatory for softtissue reconstruction. At 1year postoperation, the patient could walk a long distance without a crutch. Gastrocnemius medial flaps, interactive surgery 10. The flap size can be increase by including the skin overlying the muscle.
A thick layer of adipofascial tissue can be easily identified at the abdominal region, and this flap may also be used to protect the alloplastic. Although each muscle flap has advantages and disadvantages, the flaps were useful. In the human, soleus is a complex multipennate muscle, usually having a separate posterior aponeurosis from the gastrocnemius muscle. Functional deficit is therefore prevented as the muscle remains in place. We retrospectively examined the records of patients who had an unhealed transtibial amputation stump who were then. Knee extensor loss and proximal tibial soft tissue defect. The application of the medial gastrocnemius muscle flap was demonstrated in different situations, with satisfactory results and easy reproducibility. A gastrocnemius heterotopical transplant model with endto. A case report on bilateral knee coverage following septic arthritis.
The posterior and anterior surfaces of the muscle fascia can. Gastrocnemius muscle flap coverage of persistent wounds and areas of skin necrosis following total knee arthroplasty should be considered. The muscle flap was turned over, and transferred to the patellar region. Other options are an extended medial gastrocnemius muscle flap or myocutaneous flap, which. In symptomatic patients, there can appear pain or discomfort on physical exertion of the affected limb, but also. Rat gastrocnemius muscle anatomy home rat gastrocnemius muscle anatomy posted on rat gastrocnemius muscle anatomy author rat external an overview of the anatomy of the rat hind limb. A 15cm longitudinal incision was made 3cm behind the posteromedial border of the tibia. Gastrocnemius muscle herniation as a rare differential. The role of gastrocnemius muscle flap for reconstruction of large soft tissue defects after infected total knee arthroplasty article pdf available january 2017 with 179 reads how we measure. After the debridement of necrotic tissue in the sacral region, the skin and soft tissue defects were reconstructed with a gastrocnemius myocutaneous flap pedicled with femoral vessels after the left thigh amputation. Pdf the gastrocnemius muscle flap for coverage of soft. Proceed from inferiormedial to superiorlateral divide insertion only after pedicle is. The gastrocnemius muscle flap for reconstruction of the.
Gastrocnemius muscle flap can only cover small wound in the proximal tibia. However, the 2d photographs showed minimal significant change in the volume of the gastrocnemius muscle. Gastrocnemius muscle an overview sciencedirect topics. The gastrocnemius muscle on both medial and lateral sides exhibited reduction in volume as demonstrated in the 2d photographs. The gastrocnemius muscle gastroc has a medial head and a lateral head, supplied. To prevent neural contamination in the abdominal region, the muscle was wrapped with a 0. Islanded gastrocnemius musculocutaneous flap for coverage. The gastrocnemius muscle plural gastrocnemii is a superficial twoheaded muscle that is in the back part of the lower leg of humans. Reconstruction with a gastrocnemius muscle medial head. Correlations and coherence of monopolar emgcurrents of the medial gastrocnemius muscle in proximal and distal compartments.
Flexion and extension osteotomy of the proximal tibia. The aim of this study was to evaluate the results of complicated total knee arthroplasty operations treated with radical wound revision and a pedicled gastrocnemius muscle flap. Practical techniques in flap surgery yuichi hirase auth. Muscle flaps medial gastrocnemius, lateral gastrocnemius. The functional free innervated medial gastrocnemius flap. Figure 1 a 28yearold man suffered a postburn unhealed wound around the right knee that was managed with pedicled gastrocnemius flap. Unhealed amputation stumps after transtibial amputation are common and often require reamputation futher up the leg.
The major and secondary vascular pedicles are identified. The gastrocnemius with soleus bimuscle flap request pdf. Edl dissection david waning indiana university youtube. Transfer of a gastrocnemius muscle flap is a simple and safe procedure in the treatment of lower limb injuries. We performed reconstruction with a gastrocnemius muscle medial head flap in 4 patients with posttka infection. An early complication in the donor site of the medial.
301 1491 1157 966 1605 1460 481 509 1108 905 619 1096 1499 489 511 1273 802 757 495 624 516 658 619 347 464 267 1007 1079 1173