Vol. 5, Issue 3 (2019)
Evaluation of the gastrocnemius muscle flap for coverage of upper third leg defect
Author(s): Dr. Shyam Kumar Satyapal
Abstract: Covering complex lower limb wounds is a major challenge. The medial gastrocnemius muscle flap is usually indicated for reconstruction of loss of substance of the knee and proximal third of the leg. The objective of this study was to evaluate the results using gastrocnemius muscle flaps in lower limb wounds. A total of 25 patients with loss of substance in the lower limbs were treated with gastrocnemius muscle flaps. Data were obtained from clinical records of patients who underwent surgery from January 2016 to December 2016. In 25 patients (20 male and 5 female) with the mean age of 34.13 years (14 to 65). The etiology of the lesions was a road traffic accident accident in all cases leading to soft tissue loss with exposed tibia. In all 25 patients, adequate coverage was provided by gastrocnemius muscle flap. The medial Gastrocnemius Muscle flap was done in 21 patients, and the lateral Gastrocnemius Muscle flap was done in 4 patients. The maximum width of the defect in our series was 10 cm, and the maximum length of the defect was 18 cms. Minor complications were noted in 6 patients but they all settled with conservative management. No case of muscle flap necrosis was found. The period of hospitalization was 15 - 20 days. The follow-up period for earlier operated patients is more than two years. Transfer of a gastrocnemius muscle flap is a simple and safe procedure in the treatment of lower limb injuries. The application of the gastrocnemius muscle flap was demonstrated in different situations, with satisfactory results and easy reproducibility. The present study was planned in the Department of Plastic Surgery, Pulse Emergency Hospital, Patna, Bihar. Total 25 cases operated from Jan 2016 to Dec 2016 were included in the present study. The cases of large post-traumatic defect in upper third of leg were treated with gastrocnemius Muscle flap in department of plastic surgery. All cases were initially treated with debridement and, in some cases, fixation of fractured bone with external fixator. The data generated from the present study concludes that fewer complications would result with careful preoperative evaluation and surgical planning, adequate debridement of bone and soft tissue and the transfer of healthy, non-traumatized muscle. When these basic surgical tenets are not violated, gastrocnemius muscle provides the best form of coverage for the defects located over upper one third of tibia and knee joint.
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