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• :The Gastrocnemius muscle flap is a versatile flap for coverage of defects in & around knee. We are presenting here a series of cases with some modifications of the standard surgical technique to widen the area of it’s applications to cover the greatest part of the lower extremity.
EXTENDED MEDIAL GASTROCNEMIUS
MYOCUTANEOUS FLAP• In few patients with large defect over the
lower thigh & anterolateral kneejoint coverage was given by an extended MGMC flap, in which skin paddle is islanded along with condylar deinsertion of muscle , to provide an extra length to arc of rotation of flap.
CONDYLE DEINSERTION OF MUSCLE FLAP
• In few patients with small defects over patella /exposed implants ,after condyle deinsertion of muscle ,it was rotated on it’s neurovascular pedicle of medial sural vessels.
• In 2 patients with large longitudinal defects over upper 1/3 of tibia ,muscle flap was used for covering upper part of defect & it’s overlying skin flap for lower part , based on proximal most myo cutaneous perforator.
• In 1 patient with 2 small defects over upper part of tibia , coverage was given by longitudinally splitting the muscle belly.
• In 2 patients with large defect over middle 1/3 of tibia ,coverage was given my MGMC cross leg flap.
• Scarifications of the fascia of the muscle was done to widen the flap for coverage of large defects.
• Myo cutaneous perforators offers the advantage harvesting a skin paddle overlying the muscle with skin length/width ratio of 3.5/1(instead of <1.5/1)
• Errik R A covered a defect of 17*20cm proximal to knee. According to him island pedicle rotation advancement MGMC flap provides skin coverage extending to 70% of circumference of popliteal fossa.
• Warrier satish writes that in his study the extended MGMC flap used for extensor reconstruction,is unique in that it has no extensor lag as well as complete flexion of knee.
• Bashir ha described distally based gastrocnemius flap , based on anastomosis between medial & lateral gastrocnemius muscle. It’s possible to divide the muscle into two sections longitudinally upto half of it’s length according to need ,because of longitudinal blood supply of muscle belly.
• Bashir ha described distally based gastrocnemius flap , based on anastomosis between medial & lateral gastrocnemius muscle. It’s possible to divide the muscle into two sections longitudinally upto half of it’s length according to need ,because of longitudinal blood supply of muscle belly.
• The large caliber of blood vessel is compatible with the creation of a local free flap.
• Kramer de Quervan IA have shown that donor site morbidity after harvest of one head of gastrocnemius muscle is mild in subjects who have had a complete recovery from the initial injury. Normal level gait was possible , however deficit was seen in more demanding tasks such as fast walking or uphill walking.
• The Gastrocnemius muscle flap is a versatile for coverage of defects in & around knee. It’s easily mobilized & very dependable. It has a constant vascular anatomy ,it’s dissection is easy to perform ,it’s dimensions & possibility to harvest a myocutaneous unit allow it to be a reference flap for the coverage of defect over the proximal 2/3 of leg , knee & the distal femoral region.
• Medial gastrocnemius muscle can be expanded with little or no deficit when walking or in normal movements. The only drawback we can think of are related to it’s use as a myocutaneous flap( thickness reduction of arc of rotation ,cosmetic after defects)
