Gastrocnemius Flap for Proximal Leg Reconstruction

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0085 ◽

2019 ◽

pp. 863-872

Author(s):

Howard N. Langstein ◽

Elaina Y. Chen ◽

Nicholas A. Wingate

Keyword(s):

Operative Technique ◽

Gastrocnemius Muscle ◽

Myocutaneous Flap ◽

Muscle Flap ◽

Medial Head ◽

Gastrocnemius Flap ◽

Lateral Head

The gastrocnemius muscle flap has long been known as a workhorse flap for leg reconstruction given its reliability and ease of harvest. Its utility is varied, but it is especially useful for deep wounds of the proximal third of the leg with exposed vital structures or hardware. This chapter describes the preoperative markings and operative technique for the standard harvest of the medial head of the gastrocnemius muscle, with variations such as island muscle flap, lateral head of gastrocnemius muscle flap, and gastrocnemius myocutaneous flap. Alternatives such as propeller flaps are discussed as well. The gastrocnemius flap is one of many reliable and versatile flaps that plastic surgeons have in their armamentarium of options to reconstruct any defect of the leg.

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Dimensional and dynamic features of mammalian gastrocnemius muscle

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1961.200.5.951 ◽

1961 ◽

Vol 200 (5) ◽

pp. 951-954 ◽

Cited By ~ 4

Author(s):

J. D. Thomson

Keyword(s):

Gastrocnemius Muscle ◽

Single Muscle ◽

Dynamic Features ◽

Tension Development ◽

Mechanical Advantage ◽

Medial Head ◽

Isometric Twitch ◽

Whole Muscle ◽

Tetanic Tension ◽

Lateral Head

Attempts were made to determine how behavior of the separate heads of the rat gastrocnemius muscle are related to give responses characteristic of the whole muscle. The lateral head is heavier and shows greater isometric twitch tension than the medial head; the sum of the twitch tensions approximates values for whole muscle. Isometric tetanus tensions of the two heads are of equal magnitude; their sum is only 68% of the value for whole muscle, the deficit being due to loss of mechanical advantage by being separated. Maximum rates of isometric twitch and tetanus tension development and decay are slower in the medial than in the lateral head. The sum of the rates of twitch development approximates the value for whole muscle; the sum of rates of tetanic tension development is 65% of the value for whole muscle, this deficit also being due to loss of mechanical advantage. The medial head has a longer latent period and twitch contraction time and a greater degree of twitch fusion than the lateral head. Load-velocity curves of separate heads are similar and resemble the responses of two halves of a single muscle split lengthwise.

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The twisted structure of the fetal calcaneal tendon is already visible in the second trimester

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02618-0 ◽

2020 ◽

Author(s):

Paweł Szaro ◽

Grzegorz Witkowski ◽

Bogdan Ciszek

Keyword(s):

Soleus Muscle ◽

Gastrocnemius Muscle ◽

Layer By Layer ◽

Second Trimester ◽

Calcaneal Tendon ◽

Medial Head ◽

Plantaris Tendon ◽

Layer Method ◽

Congenital Disabilities ◽

Lateral Head

Abstract Introduction The progress in morphological science results from the greater possibilities of intra-pubic diagnosis and treatment of congenital disabilities, including the motor system. However, the structure and macroscopic development of the calcaneal tendon have not been investigated in detail. Studies on the adult calcaneal tendon showed that the calcaneal tendon is composed of twisted subtendons. This study aimed to investigate the internal structure of the fetal calcaneal tendon in the second trimester. Materials and methods Thirty-six fetuses fixed in 10% formaldehyde were dissected using the layer-by-layer method and a surgical microscope. Results The twisted structure of the calcaneal tendon was revealed in all specimens. The posterior layer of the calcaneal tendon is formed by the subtendon from the medial head of the gastrocnemius muscle. In contrast, the anterior layer is formed by the subtendon from the lateral head of the gastrocnemius muscle. The subtendon from the soleus muscle constitutes the anteromedial outline of the calcaneal tendon. The lateral outline of the calcaneal tendon is formed by the subtendon originating from the medial head of the gastrocnemius muscle. In contrast, the medial outline is formed by the subtendon from the soleus muscle. In most of the examined limbs, the plantaris tendon attached to the tuber calcanei was not directly connected to the calcaneal tendon. Conclusions The twisted structure of the subtendons of the fetal calcaneal tendon is already visible in the second trimester and is similar to that seen in adults.

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Reconstruction of Knee Defects Using Pedicled Gastrocnemius Muscle Flap with Split-Thickness Skin Grafting: A Single Surgeon's Experience with 21 Patients

The Journal of Knee Surgery ◽

10.1055/s-0038-1653965 ◽

2018 ◽

Vol 32 (05) ◽

pp. 463-467

Author(s):

Ali Kilic ◽

Brad Denney ◽

Jorge de la Torre

Keyword(s):

Gastrocnemius Muscle ◽

Muscle Flap ◽

Skin Grafting ◽

Surgical Results ◽

Defect Reconstruction ◽

Gastrocnemius Flap ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Exposed Bone ◽

Surgical Options

AbstractGenerally, reconstruction of knee defects with exposed bone, joint, tendon, and/or hardware requires a vascularized muscle flap for coverage. Although there are several surgical options for a knee defect reconstruction, the pedicled gastrocnemius muscle still remains the workhorse flap. Although this flap is commonly used for knee defect reconstruction and the technique is described very well, there is an absence of information in the literature detailing the technique of harvesting and insetting of the gastrocnemius flap step by step with illustrations. The purpose of this article is to describe in detail the technique to reconstruct defects of the knee with pedicled gastrocnemius muscle flap as well as to present demographics and surgical results of 21 patients who had knee reconstruction with a pedicled gastrocnemius muscle flap and split-thickness skin grafting.

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Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02496-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Weiwei Ruan ◽

Menglu Li ◽

Qiaofeng Guo ◽

Bingyuan Lin

Keyword(s):

Phase I ◽

Calcium Sulfate ◽

Tibial Plateau ◽

Gastrocnemius Muscle ◽

Tibial Plateau Fracture ◽

Muscle Flap ◽

Iliac Bone ◽

Type Iii ◽

Plateau Fracture ◽

Fracture Surgery

Abstract Purpose To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. Methods From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications. Results All patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87). Conclusion Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

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The Segmental Gastrocnemius Muscle Flap: Anatomical Study and Clinical Applications

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000221259.13173.1d ◽

2006 ◽

Vol 118 (5) ◽

pp. 1178-1182 ◽

Cited By ~ 2

Author(s):

Rony A. Moscona ◽

Lucian Fodor ◽

Yaron Har-Shai

Keyword(s):

Gastrocnemius Muscle ◽

Muscle Flap ◽

Anatomical Study ◽

Clinical Applications

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Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury

Neurosurgery ◽

10.1227/neu.0000000000001166 ◽

2015 ◽

Vol 78 (4) ◽

pp. 546-551 ◽

Cited By ~ 4

Author(s):

Gang Yin ◽

Huihao Chen ◽

Chunlin Hou ◽

Jianru Xiao ◽

Haodong Lin

Keyword(s):

Nerve Injury ◽

Gastrocnemius Muscle ◽

Tibial Nerve ◽

Nerve Transfer ◽

Obturator Nerve ◽

Surgical Reconstruction ◽

Sacral Plexus ◽

Medial Head ◽

Anterior Branch ◽

The Mean

Abstract BACKGROUND: Lower-limb function is severely impaired after sacral plexus nerve injury. Nerve transfer is a useful reconstructive technique for proximal nerve injuries. OBJECTIVE: To investigate the clinical effectiveness and safety of transferring the ipsilateral obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle to recover knee and ankle flexion. METHODS: From 2007 to 2011, 5 patients with sacral plexus nerve injury underwent ipsilateral obturator nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age was 31.4 years (range, 19-45 years), and the mean interval from injury to surgery was 5.8 months (range, 3-8 months). The anterior branch of the obturator nerve was coapted to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle by autogenous nerve grafting. RESULTS: Patient follow-up ranged from 24 to 38 months. There were no complications related to the surgery. Three patients recovered to Medical Research Council grade 3 or better in the medial head of the gastrocnemius muscle. Thigh adduction function was not affected in any patient. CONCLUSION: Knee and ankle flexion can be achieved by transferring the anterior branch of the obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle, which is useful for balance. This procedure can be used as a new method for treating sacral plexus nerve injury.

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The New Tongue

Otolaryngology ◽

10.1177/019459988209000111 ◽

1982 ◽

Vol 90 (1) ◽

pp. 58-68 ◽

Cited By ~ 13

Author(s):

John Conley ◽

Michael E. Sachs ◽

Robert B. Parke

Keyword(s):

Malignant Tumors ◽

Myocutaneous Flap ◽

Pectoralis Major Muscle ◽

Muscle Flap ◽

Pectoralis Major ◽

Nerve Supply ◽

The Status ◽

Peripheral Aspect ◽

New Phase ◽

Segmental Innervation

Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rationale of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a “new tongue” by the use of this flap. The criteria for these techniques in benign and malignant tumors of the tongue are outlined. The segmental innervation of the pectoralis major muscle from a variety of three to five nerve branches permits the development of a skin-muscle flap that may be transposed with its nerve supply intact or totally denervated, depending upon the status of the hypoglossal nerves and tongue in the operative field. This presents the possibility of transposing a skin-muscle flap into a glossal wound with a completely intact nerve supply where the new flap is under constant instruction in its new physiologic environment. It also presents the possibility of neurotization of the denervated section of the muscle flap by axones from the intact segment of tongue. A third possibility is the fabrication of a “new tongue” by the transfer of the hypoglossal nerves into the denervated segment of the peripheral aspect of the myocutaneous flap. This variety and combination of rehabilitative techniques introduces a new phase into the rehabilitation of the tongue.

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