Panse Nikhil, Bhadgale Rahul, Karanjkar Ankur, Phulwer Rohit, Sahasrabudhe Parag, Ramteke Chaitanya
Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India.
World J Plast Surg. 2018 Sep;7(3):319-325. doi: 10.29252/wjps.7.3.319.
Gastrocnemius muscle and musculocutaneous flaps are very versatile and one of the commonly used flaps for lower extremity reconstruction. There is significant literature available on the use of these flaps. However, we feel that the potential of the gastrocnemius musculocutaneous (GMC) flaps has not yet been fully explored in terms of increasing their reach, viability and arc of rotation. An attempt is made to refine the technique of flap harvestation to optimize outcomes of this versatile flap.
Six patients of complex lower limb defects were managed using the GMC flaps. Harvesting of the flap was always initiated from the posterior midline to include the proximal sural pedicle, sural nerve, short saphenous vein and the muscle belly of either the medial or the lateral gastrocnemius muscle along with the cutaneous paddle. All the flaps were islanded and denervated. The origin of the gastrocnemius muscle was detached in all cases to increase the reach of this flap.
The flap can reliably and comfortably cover defects from middle third-lower third junction of thigh and the entire posterior aspect of the thigh. Such a local option offers relatively simple but more cost-effective approach to complex clinical problem with tolerable impairment of the donor site.
The GMC flap can be considered as a worthwhile alternative to free-tissue transfer for limb salvage.
腓肠肌肌皮瓣用途广泛，是下肢重建常用的皮瓣之一。关于这些皮瓣的应用已有大量文献。然而，我们认为腓肠肌肌皮瓣（GMC）在增加其覆盖范围、存活能力和旋转弧度方面的潜力尚未得到充分探索。我们试图改进皮瓣切取技术，以优化这种多功能皮瓣的治疗效果。
6例下肢复杂缺损患者采用GMC皮瓣治疗。皮瓣切取总是从后中线开始，包括近端腓肠神经营养血管蒂、腓肠神经、小隐静脉以及内侧或外侧腓肠肌的肌腹和皮瓣。所有皮瓣均制成岛状并去神经化。所有病例均切断腓肠肌起点以增加皮瓣的覆盖范围。
该皮瓣能够可靠且轻松地覆盖大腿中下段交界处及整个大腿后侧的缺损。这种局部皮瓣为复杂临床问题提供了相对简单但更具成本效益的方法，供区损伤可耐受。
GMC皮瓣可被视为肢体 salvage 游离组织移植的一种有价值的替代方法。
