From the Division of Plastic Surgery, Dalin Tzu Chi Hospital.
School of Medicine, Tzu Chi University.
Plast Reconstr Surg. 2024 Sep 1;154(3):531-541. doi: 10.1097/PRS.0000000000010839. Epub 2023 Jun 19.
Selective neurectomy or muscle resection techniques for calf reduction conventionally focus on the gastrocnemius muscle. However, the underlying soleus muscle plays an important role in muscular calf hypertrophy. In the authors' experience, the results of calf reduction have been suboptimal in patients with severe muscular calf hypertrophy who underwent gastrocnemius muscle resection only. This article describes a new calf reduction method that uses concurrent gastrocnemius muscle resection and soleus muscle neurectomy using an endoscope-assisted single-incision approach in patients with severe muscular calf hypertrophy.
A total of 139 patients who underwent simultaneous gastrocnemius muscle resection and soleus muscle neurectomy for severe calf hypertrophy from March of 2017 to June of 2020 were retrospectively analyzed.
After combined gastrocnemius resection (mean weight per calf, 349 g) and soleus neurectomy, about 3.8 to 8.2 cm (mean, 6.4 cm) or 12.8% to 24.3% (mean, 16.6%) of the calf was reduced. Complications included cellulitis, hematoma, seroma, and mild depression ( n = 1 each). Two patients had traction injury to the sural nerve. One patient developed Achilles tendon rupture at 2 months postoperatively. No patient complained of functional impairment with respect to easy fatigability, stability, gait, or sport activities at 6 months postoperatively.
This study is the first to combine gastrocnemius muscle resection with selective soleus muscle neurectomy to achieve the most efficient calf reduction for severe muscular calf hypertrophy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
传统的小腿缩小术式，如选择性神经切断术或肌肉切除术，主要针对腓肠肌。然而，跟腱肌在肌肉性小腿肥大中起着重要作用。作者的经验表明，对于仅接受腓肠肌切除术的严重肌肉性小腿肥大患者，小腿缩小术的效果并不理想。本文介绍了一种新的小腿缩小方法，该方法采用内镜辅助单切口入路，同时行腓肠肌切除术和比目鱼肌神经切断术，用于治疗严重肌肉性小腿肥大。
回顾性分析了 2017 年 3 月至 2020 年 6 月期间，因严重小腿肥大而行同时行腓肠肌切除术和比目鱼肌神经切断术的 139 例患者。
联合腓肠肌切除（每侧小腿平均重量，349 g）和比目鱼肌神经切断后，小腿缩小约 3.8 至 8.2 cm（平均 6.4 cm）或 12.8%至 24.3%（平均 16.6%）。并发症包括蜂窝织炎、血肿、血清肿和轻度凹陷（各 1 例）。2 例患者出现腓肠神经牵拉损伤。1 例患者术后 2 个月发生跟腱断裂。术后 6 个月，无患者主诉易疲劳、稳定性、步态或运动活动功能受损。
本研究首次将腓肠肌切除术与选择性比目鱼肌神经切断术相结合，用于治疗严重肌肉性小腿肥大，达到了最有效的小腿缩小效果。
临床问题/证据水平：治疗性，IV 级。
