gastrocnemius flap

Gastrocnemius flap

Dr sumer yadavMch plastic surgeon

sumeryadav2004@gmail.com

• :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.

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

sumeryadav2004@gmail.com

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.

sumeryadav2004@gmail.com

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.

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• In 1 patient with 2 small defects over upper part of tibia , coverage was given by longitudinally splitting the muscle belly.

sumeryadav2004@gmail.com

• In 2 patients with large defect over middle 1/3 of tibia ,coverage was given my MGMC cross leg flap.

sumeryadav2004@gmail.com

• Scarifications of the fascia of the muscle was done to widen the flap for coverage of large defects.

sumeryadav2004@gmail.com

• 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)

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• 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.

sumeryadav2004@gmail.com

• 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)

sumeryadav2004@gmail.com