gastrocnemius flap

gastrocnemius flap

1. Gastrocnemius flap
Dr sumer yadav
Mch plastic surgeon
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2. •: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.
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21. 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.
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22. 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.
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23. •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.
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24. •In 1 patient with 2 small defects over
upper part of tibia , coverage was given by
longitudinally splitting the muscle belly.
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25. •In 2 patients with large defect over middle
1/3 of tibia ,coverage was given my
MGMC cross leg flap.
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26. •Scarifications of the fascia of the muscle
was done to widen the flap for coverage of
large defects.
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27. •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)
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28. •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.
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29. •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.
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30. •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.
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31. •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.
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32. •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.
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33. • 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)
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