The split medial gastrocnemius muscle flap.
Plastic & Reconstructive Surgery (Impact Factor: 3.54). 11/1998; 102(5):1782-3. DOI:10.1097/00006534-199810000-00108
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ABSTRACT: The treatment of Gustilo Anderson type 3B open fracture tibia is a major challenge and it needs aggressive debridement, adequate fixation, and early flap coverage of soft tissue defect. The flaps could be either nonmicrovascular which are technically less demanding or microvascular which has steep learning curve and available only in few centers. An orthopedic surgeon with basic knowledge of the local vascular anatomy required to harvest an appropriate local or regional flap will be able to manage a vast majority of open fracture tibia, leaving the very few complicated cases needing a free microvascular flap to be referred to specialized tertiary center. This logical approach to the common problem will also lessen the burden on the higher tertiary centers. We report a retrospective study of open fractures of leg treated by nonmicrovascular flaps to analyze (1) the role of nonmicrovascular flap coverage in type 3B open tibial fractures; (2) to suggest a simple algorithm of different nonmicrovascular flaps in different zones and compartment of the leg, and to (3) analyze the final outcome with regards to time taken for union and complications. One hundered and fifty one cases of Gustilo Anderson type 3B open fracture tibia which needed flap cover for soft tissue injury were included in the study. Ninety four cases were treated in acute stage by debridement; fracture fixation and early flap cover within 10 days. Thirty-eight cases were treated between 10 days to 6 weeks in subacute stage. The rest 19 cases were treated in chronic stage after 6 weeks. The soft tissue defect was treated by various nonmicrovascular flaps depending on the location of the defect. All 151 cases were followed till the raw areas were covered. In seven cases secondary flaps were required when the primary flaps failed either totally or partially. Ten patients underwent amputation. Twenty-two patients were lost to followup after the wound coverage. Out of the remaining 119 patients, 76 achieved primary acceptable union and 43 patients went into delayed or nonunion. These 43 patients needed secondary reconstructive surgery for fracture union. open fracture of the tibia which needs flap coverage should be treated with high priority of radical early debridement, rigid fixation, and early flap coverage. A majority of these wounds can be satisfactorily covered with local or regional nonmicrovascular flaps.Indian Journal of Orthopaedics 07/2012; 46(4):462-9. · 0.74 Impact Factor
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ABSTRACT: The versatility of the gastrocnemius muscle for reconstruction of defects in the knee region from the upper third of the calf to the lower third of the thigh is well known. Possible limitations of this flap include difficulties in covering multiple separate wounds in the same area as well as contour deformity because of the flap bulkiness. The findings in this study extend the versatility of the gastrocnemius muscle flap by splitting each head into two segments allowing for the closure of multiple defects. Studied was the vascular anatomy of 15 fresh cadaveric lower extremities. Contrast material was injected into the sural artery and this showed the bifurcation of the pedicle in the upper third of the muscle. A constant intramuscular vascular pattern represented by two main longitudinal branches permitted the safe division of each head. Based on these anatomic studies, segmentation was performed of the gastrocnemius muscle flap in 29 patients. In 13 cases were used, one or two muscle segments and in 16 cases, three muscle segments were transposed. All of the flaps survived. Minor complications, such as wound dehiscence, cellulitis, or hematoma, were encountered in seven patients. Except for one patient with persistent drainage from osteomyelitic bone, all the wounds closed successfully. The authors report the safe splitting of the distal gastrocnemius muscle in 29 patients based on vascular anatomic studies. The advantages of gastrocnemius segmentation include the possibility of covering multiple defects with less contour deformity.Plastic and reconstructive surgery 11/2006; 118(5):1178-82. · 2.74 Impact Factor
Conference Proceeding: Power electronics-based T&D controllers technology developments[show abstract] [hide abstract]
ABSTRACT: Power electronics is one of the fastest changing "enabling infrastructure technologies" in electrical engineering. It has made and continues to make a significant impact on power and energy infrastructures, which constitute one of the pillars of the foundation of our society and the rest of the world. Power electronics-based transmission controllers are the key elements for transforming a transmission system from being a "passive" to be an "active" system, i.e., flexible, controllable and securely utilizable up to its thermal capacity. Currently, the power electronics-based transmission controllers are at a technological crossroad towards improving operating reliability, lowering development costs, and introducing innovative technical functionality and controllability options. This paper presents an overview for technology evolution of transmission & distribution controllers, from thyristor-based technology to the voltage-sourced converter-based technology. The paper also outlines a "roadmap" for future developments.Transmission and Distribution Conference and Exposition, 2003 IEEE PES; 10/2003
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