[The gastrocnemius muscle flaps].

OBJECTIVE

Defect reconstruction by transposition of well-vascularized muscle (muscle flap) or muscle/skin tissue (myocutaneous flap). Reconstruction of missing muscle unit by free functional muscle transplantation.

INDICATIONS

Treatment of first choice for defect coverage at the distal thigh, knee (including exposed and infected total knee prosthesis), and proximal lower leg.

CONTRAINDICATIONS

Lesions of the popliteal artery. Concomitant lesion of the soleus muscle (impaired plantar flexion).

SURGICAL TECHNIQUE

Proximally pedicled flap: the distal tendinous insertion of the medial and/or lateral gastrocnemius muscle at the Achilles tendon is cut. Vascularization is assured by the medial and lateral sural artery, respectively. - Muscle flaps (medial gastrocnemius, lateral gastrocnemius). - Muscle-skin (myocutaneous) flaps. Distally pedicled flap: the proximal tendinous origin of the medial or lateral gastrocnemius muscle is cut. Vascularization is assured by vascular anastomoses between the two muscles crossing the midline. Because of its unpredictable vascularization, especially after trauma, this technique is rarely used today. To improve arterial inflow, the cut sural artery can be anastomosed in microsurgical technique with an adequate arterial blood vessel at the recipient site.

POSTOPERATIVE MANAGEMENT

Complete immobilization for 5-7 days (knee and ankle joints). Progressive increase of range of motion after 1 week (30 degrees /45 degrees /60 degrees /90 degrees ). Postoperative standardized compression therapy, combined with scar therapy (silicone sheet).

RESULTS

Reliable, excellent functional and aesthetic results.