Articles Vol. 66 No. CĐ9-NCKH 22/08/2025

7. GASTROCNEMIUS MUSCLE FLAP FOR COVERAGE OF SOFT TISSUE DEFECTS IN THE PROXIMAL THIRD OF THE LEG

Nguyen Tan Bao An1,2, Vo Hoa Khanh3,4, Bui Thanh Toan5,6, Mai Trong Tuong3,4
1 University of Medicine and Pharmacy at Ho Chi Minh city
2 Đại học Y Dược thành phố Hồ Chí Minh
3 Hospital for Traumatology and Orthopaedics Ho Chi Minh city
4 Bệnh viện Chấn thương Chỉnh hình thành phố Hồ Chí Minh
5 Nguyen Tri Phuong Hospital
6 Bệnh viện Nguyễn Tri Phương
Corresponding author: thanhtoanbui6@gmail.com
DOI: 10.52163/yhc.v66iCD9.2673
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Keywords
Gastrocnemius flap soft tissue defect upper third of leg.
Abstract

Objective: Evaluation of the ability to cover soft tissue defects in the upper leg area with the gastrocnemius muscle flap.

Subject and method: A prospective case series was conducted on 19 patients with soft tissue defects in the proximal third of the leg (with exposed tendon, bone, or internal fixation) who underwent reconstruction using a pedicled gastrocnemius muscle flap. These cases were treated at the Department of Microsurgery and Reconstruction, Hospital for Traumatology and Orthopaedics Ho Chi Minh city from January 2020 to December 2024. All patients were followed for at least 2 months postoperatively to evaluate flap viability and outcome.

Results: Complete flap survival was achieved in 18 of 19 cases (94.7%). In 17 patients the medial head of the gastrocnemius was used, and in 2 patients the lateral head was used. There was one case (5.3%) of total flap necrosis. Notable complications included one case of donor-site hematoma (requiring surgical evacuation) and one case of marginal skin necrosis around the flap resulting in bone exposure (requiring an additional local flap for coverage). The soft tissue defect sizes ranged from 3 × 4 cm to 7 × 8 cm. The gastrocnemius flaps were able to cover defects at various locations: primarily the anterior proximal tibia (15 cases, 78.9%), some involving the knee region (3 cases, 15.8%), and one case at the junction between the upper and middle thirds of the lower leg (5.3%).

Conclusion: The gastrocnemius muscle flap proved to be a reliable solution for covering soft tissue defects in the proximal leg region. This flap can be designed to cover sizable defects due to its ample bulk and pedicle length with robust blood supply, and the harvest technique is relatively straightforward. However, when using the gastrocnemius flap as an island flap with near 180° rotation, one must take care to avoid pedicle kinking or compression. Incorporating a skin paddle with the muscle flap can also help extend the flap’s reach and coverage area when necessary.

References
[1]
Ajri R, Qader M.B.Ch.B. The gastrocnemius muscle flap used as cover for exposed upper tibia. Duhok Medical Journal, 2010, 4 (2): 60-68. Google Scholar
[2]
Amgad H, Abdellah M.A. Split gastrocnemius muscle flap. Egyptian Journal of Plastic and Reconstructive Surgery, 2003, 27 (2): 181-187. Google Scholar
[3]
Khan A.H, Ahmad Q.G. Gastrocnemius muscle flaps for coverage of knee and upper tibial defects. Plastic and Reconstructive Surgery, 2003, 37 (2): 12-14. Google Scholar
[4]
Mathes S.J, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plastic and Reconstructive Surgery, 1981, 67: 177. Google Scholar
[5]
Mai Trọng Tường. Các vạt da-cơ tại chỗ che phủ mất da vùng gối. Kỷ yếu Hội nghị Chấn thương Chỉnh hình thành phố Hồ Chí Minh lần thứ 14, 2007, tr. 170-175. Google Scholar
[6]
McCraw J.B, Arnold P.G. McCraw & Arnold’s Atlas of Muscle and Musculocutaneous Flaps. Hampton Press, 1986, 491-543. Google Scholar
[7]
McCraw J.B, Fishman J.H, Sharzer L.A. The versatile gastrocnemius myocutaneous flap. Plastic and Reconstructive Surgery, 1981, 62: 15. Google Scholar
[8]
Neale H.W, Stern P.J, Kreilein J.G. Complications of muscle-flap transposition for traumatic defects of the leg. Plastic and Reconstructive Surgery, 1983, 72 (4): 512-517. Google Scholar
[9]
Ngô Xuân Khoa, Nghiên cứu giải phẫu vạt da-cơ bụng chân ứng dụng trong phẫu thuật tạo hình. Tạp chí Y học thực hành, 2013, 6, tr. 170-173. Google Scholar
[10]
Nguyễn Anh Tuấn. Che phủ lộ xương bánh chè vùng gối. Tạp chí Y học thành phố Hồ Chí Minh, 1999. Google Scholar
[11]
Potparic Z, Colen L.B, Sucur D, Carraway J.H. The gastrocnemius muscle as a free flap donor site. Plastic and Reconstructive Surgery, 1995, 95: 1245-1252. Google Scholar
[12]
Walton Z, Armstrong T, Traven S, Leddy L. Pedicled rotational medial and lateral gastrocnemius flaps: surgical technique. Journal of the American Academy of Orthopaedic Surgeons, 2017, 25 (10): 744.751. Google Scholar