scholarly journals The Use of Gastrocnemius Muscle Flap in Reconstruction of Pretibial Defects

2015 ◽  
Vol 12 (1) ◽  
pp. 2-5
Author(s):  
Binod Karn

Background: In Western part of Nepal the post traumatic lower leg and bone injuries with infected, open wound is common occurrence.Aim: It was to find out whether Gastrocnemius muscle flap is a viable option for pretibial defects. However variations in vascular anatomy of pedicle, use of reverse flow soleus muscle flap based on posterior tibial artery, leads to high failure rate and sacrificing major leg vessels.Method: Use of soleus muscle flap supported by perforating arteries, branches of posterior tibial vessels is option to cover small defects. The flap with careful newer modification to preserve vascularity, is used in 32 cases of pretibial defects.Observation: All 32 flaps survived with two cases in post operative phase, needing a flap elevation debridement of underlying bone and other skin grafting.Result: None of the case showed any vascular insufficiency, graft muscle loss or any functional loss. Use of muscle flap a viable option in pretibial defects.Journal of Nepalgunj Medical College Vol.12(1) 2014: 2-5

2016 ◽  
Vol 2 (1) ◽  
pp. 31-37
Author(s):  
Daniel A. Wolff ◽  
Gustavo J. Armand Ugón ◽  
Jesús R. Manzani

Introducción: El éxito de éste colgajo depende de la anatomía vascular de su pedículo y de la existencia de anastomosis con pedículos proximales. Los estudios vasculares anatómicos en cadáveres fundan las bases para la realización de colgajos musculares. El cirujano debe conocer cuales de los resultados de un estudio cadavérico son aplicables al paciente. Objetivos: Estudiar en cadáveres el número de pedículos distales, su topografía y la existencia de anastomosis con vasos proximales. Luego comparar estos datos con los hallados en pacientes. Material y Métodos: En 9 piernas cadavéricas se estudió la anatomía de los pedículos distales. En 5 pacientes se realizó colgajo de hemisóleo a pedículo distal y se verificó la correspondencia de los datos cadavéricos con los hallados en el vivo. Resultados: En el grupo cadavérico los pedículos distales para el músculo sóleo se originaron tanto de la arteria tibial posterior como de la peronea. El vaso mas distal se encontró en promedio a 6,32 cm de la línea intermaleolar y su origen mas frecuente fue la arteria tibial posterior. La presencia de anastomosis no fue demostrable en las disecciones cadavéricas pero si en el vivo.       Conclusiones: Los resultados cadavéricos fueron comparables con los hallazgos del modelo vivo, salvo en la identificación de anastomosis, sólo evidenciables en éstos últimos. Esta información es útil para el abordaje y localización del pedículo distal que nutre el colgajo, pero no para definir el territorio anatómico del vaso. Por lo tanto, debe conocerse que datos originados de estudios cadavéricos pueden aplicarse al vivo. Introduction: The success of this flap depends on the vascular anatomy of its pedicle and on the existence of anastomosis with proximal pedicles. The anatomic cadaveric vascular studies set the foundation for muscle flap designs. Surgeons should know which results of cadaveric studies are applicable to the patient. Our objective was to study, in cadavers, the number and situation of distal pedicles to the soleous muscle and the existence of anastomosis between them and proximal dominant vessels for this muscle, and to compare this data with those found in patients. Material and Methods: The anatomy of distal pedicles was studied in nine cadaveric legs. Distally based hemisoleus flap was performed in five patients. The correspondence between cadaveric and patients data was verified. Results: Cadaveric group distal pedicles for soleus muscle were originated from the posterior tibial artery and also from the fibular artery. The most distal vessel was found at an average of 6.32 cm from the intermaleolar line. Its most frequent origin was the posterior tibial artery. The presence of anastomosis was demonstrated in patients but not in cadaveric dissections. Conclusions: Cadaveric results were comparable with those found in patients, except for the identification of the anastomosis. This information is useful for the localization and surgical approach of the distal pedicle that nourish the flap, but not to define the anatomical territory of the vessel. Therefore, it should be known which cadaveric data can be applied to the patients.   


1990 ◽  
Vol 86 (2) ◽  
pp. 317-318 ◽  
Author(s):  
Ke Liu ◽  
Zhutian Li ◽  
Yude Cao ◽  
Lawrence B. Colen

2008 ◽  
Vol 7 (3) ◽  
pp. 272-274 ◽  
Author(s):  
P. J. Jiji ◽  
Sujatha D'Costa ◽  
Soubhagya R. Nayak ◽  
Latha V. Prabhu ◽  
Mangala M. Pai ◽  
...  

Arterial variations of distal parts of lower extremities are well-documented and can be demonstrated with the help of Doppler ultrasound or by arteriography. However, absence or variation of posterior tibial artery is considered a rare finding. We present a case of hypoplastic posterior tibial artery that terminated by supplying soleus muscle. The variant arterial supply to the sole was provided by the enlarged peroneal artery that continued as the lateral plantar artery. The awareness of these variations is important to vascular surgeons while performing arterial reconstructions in femorodistal bypass graft procedures, and also to orthopedists during surgical clubfoot release.


2018 ◽  
Vol 47 (1) ◽  
pp. 138-143 ◽  
Author(s):  
Michelle M. Gosselin ◽  
Jacob A. Haynes ◽  
Jeremy J. McCormick ◽  
Jeffery E. Johnson ◽  
Sandra E. Klein

Background: Ankle sprains are the most common musculoskeletal injury in the United States. Chronic lateral ankle instability can ultimately require operative intervention to decrease pain and restore stability to the ankle joint. There are no anatomic studies investigating the vascular supply to the lateral ankle ligamentous complex. Purpose: To define the vascular anatomy of the lateral ligament complex of the ankle. Study Design: Descriptive laboratory study. Methods: Thirty pairs of cadaveric specimens (60 total legs) were amputated below the knee. India ink, followed by Ward blue latex, was injected into the peroneal, anterior tibial, and posterior tibial arteries to identify the vascular supply of the lateral ligaments of the ankle. Chemical debridement was performed with 8.0% sodium hypochlorite to remove the soft tissues, leaving casts of the vascular anatomy intact. The vascular supply to the lateral ligament complex was then evaluated and recorded. Results: The vascular supply to the lateral ankle ligaments was characterized in 56 specimens: 52 (92.9%) had arterial supply with an origin from the perforating anterior branch of the peroneal artery; 51 (91.1%), from the posterior branch of the peroneal artery; 29 (51.8%), from the lateral tarsal branch of the dorsalis pedis; and 12 (21.4%), from the posterior tibial artery. The anterior branch of the peroneal artery was the dominant vascular supply in 39 specimens (69.6%). Conclusion: There are 4 separate sources of extraosseous blood supply to the lateral ligaments of the ankle. In all specimens, the anterior talofibular ligament was supplied by the anterior branch of the peroneal artery and/or the lateral tarsal artery of the dorsalis pedis, while the posterior talofibular ligament was supplied by the posterior branch of the peroneal artery and/or the posterior tibial artery. The calcaneofibular ligament received variable contributions from the anterior and posterior branches of the peroneal artery, with few specimens receiving a contribution from the lateral tarsal or posterior tibial arteries. Clinical Relevance: Understanding the vascular anatomy of the lateral ligament complex is beneficial when considering surgical management and may provide insight into factors that lead to chronic instability.


2020 ◽  
pp. 112972982093748
Author(s):  
Doğan Kahraman ◽  
Uğur Şener ◽  
Tahir Olgaç ◽  
Mehmet Moda ◽  
Burak Yoğurtçuoğlu

Objective: There is no reliable secondary site for fistula creation in patients with preclusions for further use of upper extremity vessels as viable hemodialysis access. Below-knee vessels resemble the forearm vascular anatomy and, therefore, methods to improve the outcomes of fistula creation at this level would also help to improve the quality of life for those patients. The aim of the present study was to examine the efforts to improve the functionality of below-knee fistulas in a sample of dialysis patients. Methods: We retrospectively evaluated the results of ankle fistulas created following preliminary balloon dilatation of both the saphenous fascia and the saphenous vein in 11 patients who were considered eligible if they did not have concomitant venous or arterial lower extremity disease. We assessed the changes in fistula flow within 6 months as well as patency and maturation rates. Results: Though the patency rate at 6 months was 63.6% (seven patients), only three fistulas (27.3%) were used for routine dialysis. All mature fistulas were observed in patients with a preoperative posterior tibial artery flow of more than 35 mL/min. Conclusion: Saphenous vein dilation throughout the below-knee promotes fistula patency, but the posterior tibial artery shows inadequate response as an inflow supplier at the ankle level. More proximal connection of saphenous vein after balloon dilation may be used in the future to achieve adequate flow from leg arteries.


2019 ◽  
pp. 873-880
Author(s):  
Jeffrey D. Friedman ◽  
Eric S. Ruff

Open wounds in the middle third of the lower leg often require soft tissue reconstruction to allow for primary wound healing. The soleus muscle flap is uniquely suited for this purpose and is used primarily as a muscle flap without the accompanying overlying skin. This muscle has a blood supply that is segmental in nature, arising from multiple perforators from the posterior tibial vessels. Given that that this blood supply is primarily located in the proximal third of the leg, the soleus muscle flap is generally based proximally to allow for coverage of middle-third defects. While the muscle has a clear intermuscular septum which separates the medial head from the lateral segment, the use of a so-called hemi-soleus flap is less reliable and thus used on an infrequent basis. The soleus muscle flap can also be based distally in the leg for small distal-third defects; however, this flap can often be unreliable due to a paucity of sufficient perforators located in this area.


2016 ◽  
Vol 76 (6) ◽  
pp. 705-712 ◽  
Author(s):  
Georgios Drimouras ◽  
Epameinondas Kostopoulos ◽  
Christos Agiannidis ◽  
Stavroula Papadodima ◽  
Grigorios Champsas ◽  
...  

2019 ◽  
Vol 76 (7) ◽  
pp. 728-732
Author(s):  
Goran Stevanovic ◽  
Marija Dakovic-Bjelakovic ◽  
Boban Djordjevic ◽  
Jadranka Paravina ◽  
Ivan Golubovic ◽  
...  

Background/Aim. Lower-leg septocutaneous system of perforating blood vessels represents the vascular basis of fasciocutaneous flaps. Additionally, it is of a particular importance when designing distally based fasciocutaneous flaps which represent the ?workhorse? in the reconstruction of the distal third of the lower leg and foot. The aim of this study was to analyse the vascular anatomy of posterior tibial artery and its septocutaneous (fasciocutaneous) perforating arterial vessels. Methods. The dissection was conducted on 20 fetuses of both sexes and of gestational age from 20 to 28 weeks. Cluster analysis was applied to the data on vascular anatomy of posterior tibial artery and its septocutaneous performating arterial vessels. Results. A total of 212 perforating arterial vessels was identified. The average number of perforating arterial vessels was 5.32 (ranging from 4 to 7). It was identified that septocutaneous perforating blood vessels are more likely to be found at certain levels (?safe levels of finding perforators?). These are: second, third, fifth and sixth tenth (measured as a distance from intermalleolar line to popliteal crease). Conclusion. The presence of septocutaneous system of perforating blood vessels and reliability of their localization even in the fetal period allows application of these findings in the lower leg reconstructions in children of early age. It also contributes to the greater level of understanding of anatomy of the lower-leg vascular system. Finally, it provides a basis for understanding the development of this system as it is now possible to compare results obtained on fetuses with those obtained on adults.


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