The split medial gastrocnemius muscle flap.

Plastic &amp Reconstructive Surgery (Impact Factor: 3.33). 11/1998; 102(5):1782-3. DOI: 10.1097/00006534-199810000-00108
Source: PubMed
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    ABSTRACT: The aim of our study was to prove that endoscopic-assisted harvest of the medial gastrocnemius muscle is as effective as the conventional technique. We performed endoscopic dissection on 10 fresh human cadavers, and found that the medial gastrocnemius muscle was easily harvested through a minor donor-site incision, because of its topography and constant dominant proximal vascular pedicle. The operative technique is described.
    British Journal of Plastic Surgery 05/2002; 55(3):228-30. DOI:10.1054/bjps.2002.3808 · 1.29 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the feasibility of splitting each head of the gastrocnemius muscle into two segments. This prospective study was conducted on 35 fresh cadavers with injection of radio-opaque contrast material in the popliteal artery. Seventy medial gastrocnemius and 70 lateral gastrocnemius muscle specimens were obtained. Gastrocnemius intramuscular arterial anatomy was analysed by using the digital X-ray technique. The most common vascular pattern found in this study was both bellies supplied by individual sural arteries, which shows distal bifurcation. The medial sural artery always showed bifurcation in the medial gastrocnemius muscle in both lower limbs, whereas this bifurcation of the lateral sural artery was present in only 87% cases and 13% of cases showed a single lateral sural artery without bifurcation in the lateral gastrocnemius muscle. The mean pedicle length of the medial sural artery in the right lower limb was 2.1 cm, and in left lower limb 2.3 cm. The mean pedicle length of the lateral sural artery in the right lower limb was 2.44 cm and in the left lower limb 3.21 cm. The segmental vascular pattern of the medial belly of the gastrocnemius is constant, and, thus, it can be divided safely for coverage of multiple wound defects around the knee joint. The short length of the median sural artery allows for high division of the medial gastrocnemius muscle belly. The segmental vascular anatomy is not constant in the lateral belly of the gastrocnemius muscle and, hence, division of the lateral belly is not advocated without prior preoperative colour Doppler.
    Journal of Plastic Reconstructive & Aesthetic Surgery 06/2011; 64(9):1202-6. DOI:10.1016/j.bjps.2011.04.011 · 1.47 Impact Factor
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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. DOI:10.4103/0019-5413.97265 · 0.62 Impact Factor