Soleus muscle, gastrocnemius muscle flap free latissimus dorsi musculocutaneous flap free. The gastrocnemius muscle flap for reconstruction of the proximal third of lower leg. To discuss the experience with threedimensional reconstructiontechnique in initial clinical application in gastrocnemius muscle flap surgery. Rather than a distant free flap, it can be used as a local free flap. Gastrocnemius recession can be effectively used as sole treatment for remedying primary contracture or in conjunction with other reconstructive procedures as a means. Various methods of gastrocnemius recession have been described, and it is paramount the practicing foot and ankle surgeon be familiar with at least 1 technique of surgical release. Soft tissue defect of the lower leg with exposure of bone, tendon, and osteosynthesis plates or total knee artthroplasty is a challenging therapeutic problem. Gastrocnemius myotendinous flap for patellar or quadriceps. Introduction the gastrocnemius flap is one of the most useful flaps. The volume is extensively indexed and organized by anatomic region, and chapters follow a uniform format that clearly presents all the information needed on each flap indications, anatomy, blood supply, surgical techniques, complications, safeguards to keep in mind, and advantages and disadvantages of the flap. In addition to providing stepbystep instructions, postoperative care, and complications, a sample dictation is provided. The double muscle gastrocnemiussoleus flap in resurfacing.
The hemisoleus rotational flap provides a novel superior autograft. Medial gastrocnemius flap for reconstruction of the. The extended medial gastrocnemius rotational flap procedure was done using the technique described by jaureguito et al. Extended medial gastrocnemius rotational flap for treatment. The medial gastrocnemius muscle flap is not usually harvested as a free flap. The flap is widely applied to cover defects of the knee, the proximal tibia and femur 9. This classic muscle flap is now being used with increasing frequency following revision knee joint surgery. Medial achilles tendon island flapa novel technique to treat. The pedicled medial gastrocnemius flap provides a robust coverage option. In our practice, we rarely use a pedicled medial gastroc. Operative dictations in plastic and reconstructive surgery. Winner of association of american publishers best book in clinical medicine, 2007 this landmark multimedia reference presents the most current information on surgical treatments of a wide range of. Outcome of islanded gastrocnemius musculocutaneous flap in. A flap augmentation technique for achilles tendon repair.
Besides the use of debridement and sequestrectomy as a sole management option, the procedure may be combined with other procedures like muscle flap interposition, bonegrafting, primary or. What factors influence the success of medial gastrocnemius. Orthoplastic techniques for lower extremity reconstruction. Gastrocnemius flaps have been used for decades to reconstruct defects of the proximal tibia and knee.
Combined gastrocnemius soleus flaps can be used adequately without the need to resort to free flaps. Common calcaneal tenorrhaphy revision using a central gastrocnemius turnover aponeurotic flap technique in a cat. Nikhil panse, rahul bhadgale, ankur karanjkar, rohit phulwer, parag sahasrabudhe, chaitanya ramteke abstract background dvwurfqhplxv pxvfoh dqg pxvfxorfxwdqhrxv adsv duh yhu\ yhuvdwlohdqgrqhriwkhfrpprqo\xvhgadsviruorzhuhwuhplw\. Long posterior flap burgess technique zdesigned by kendrick 1956 and made popular by burgess 1969. Each chapter details the critical clinical information the surgeon needs to know to effectively harvest.
Many experimental flap models have been described with the advancement of flap surgery and research. The intermediatelevel technique was described by bauman,14 but is one with which the authors have no experience, and it involves a section of the anterior aponeurosis of the. The crossleg gastrocnemius muscle flap for leg reconstruction. Muscle flaps medial gastrocnemius, lateral gastrocnemius. Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.
Pmc, all databases, assembly, biocollections, bioproject, biosample, biosystems, books. A video of the surgical technique involving the same. Pdf pedicled gastrocnemius flap in complicated total. The well vascularized myocutaneous flap consists of gastrocnemius.
The well vascularized myocutaneous flap consists of gastrocnemius, partial soleus and posterior skin. They have proven to be useful in the softtissue reconstruction of defects caused by trauma, tumors, and infections about the knee, and the reconstruction of extensor mechanism discontinuity with and without total joint arthroplasty. The vastus medialis flap was developed by detaching the medial capsule and synovial membrane as a single layer from the tibia as far posteriorly as the mcl. In the surgical procedure, the patient was supine for both the vastus medial and lateralis flap elevation as well as the medial gastrocnemius flap. Apleys system of orthopaedics and fractures request pdf. Dec 31, 2016 this chapter describes the key steps of a medial pedicled gastrocnemius flap for soft tissue coverage of knee defects, proximal tibial wounds, and distal thigh wounds. Treatment of common calcaneal tendon rupture using a. Ger and efron 6 first published this procedure in 1970. Below knee amputationburgess long posterior flap technique posted by admin on february 8, 2015 leave a comment 0 go to comments the burgess technique is the most frequently used technique in bk amputation. There is only one vasculonervous pedicle for each of both muscle heads composed of a sural artery and one or two veins, and is classified as type i according. Advances in surgical technique has made the crossleg free flap possible although it may require long operation time along with significant donor site morbidity. Gastrocnemius, leg defect, myocutaneous flap, reconstruction. Proximal tibial defect gastrocnemius rotational flap middle tibial defect soleus rotational flap distal tibial defect free flap large defect latissimus dorsi smaller defect radial forearm, sural artery fasciocutaneous flap.
Lamm, paley, and herzenberg advocate their technique of a gastrocnemius soleus recession through a posterior midline approach 26. The reach of the gastrocnemius musculocutaneous flap. The distal open techniques are described in the article surgical techniques of gastrocnemius lengthening by dr. Pearls and tips in coverage of the tibia after a high. Msmd processing is a melt blending technique without any porogens and solvents, therefore it is considered clean. Differentiation capacity of umbilical cord derived stem cells cultured in various kinds of media.
A spindleshaped skin island design has minimal donor site morbidity when the donor site is closed primarily or when it is skingrafted. The use of the gastrocnemius muscle flap is one method of choice for reconstruction of the anterior and medium side of the knee as well as the proximal third part of lower leg 5. Typically, it can be used by nonspecialized reconstructive surgeons, since its field of application concerns the area of the knee and upper part of the. Pdf differentiation capacity of umbilical cord derived stem. And in addition microsurgical techniques can greatly enhance the mobility and length of the flap when used locally. The gastrocnemius muscle flap is one option for coverage. The gastrocnemius intramuscular aponeurotic recession. It is very useful for treating defects that affect the proximal third tibia of the leg and anterior and medial region of the knee, such as the loss of substance after fractures. Gastrocnemius flap for proximal tibia and knee wound coverage. Both patients were treated with onestage debridement and extended medial gastrocnemius rotational flap reconstruction.
Threedimensional reconstruction technique in gastrocnemius. The book provides stepbystep operative details regarding all indexed plastic. To discuss the experience with threedimensional reconstruction technique in initial clinical application in gastrocnemius muscle flap surgery. Howard langstein, elaina y chen, nicholas wingate edited by. Although there are several techniques for providing coverage after. The surgical technique is described and the versatility of the flap is demonstrated with several examples and discussed showing how both the medial and the lateral gastrocnemius flap, can be used. Gastrocnemius musculocutaneous flap is a simple and reliable solution for coverage of large wounds around the knee and proximal half of the leg.
The pclcs scaffolds are specifically designed for enhancing osteoconductive. The high gastrocnemius recession refers to a medial approach, strayer type of recession 27. Gastrocnemius rotation flap technique orthopaedicsone. Gastrocnemius recession lengthens the muscles and tendons at the back of the leg, allowing the heel to shift downward into a more natural position. This video demonstrates via cadaver dissection the technique for using a medial gastrocnemius flap rotated.
From 2007 to 2008, 7 patients received gastrocnemius muscle flapsurgeries to repair the wounds. From 2007 to 2008, 7 patients received gastrocnemius muscle flapsurgeries to repair the. Seven parts organized anatomically detail flaps used for the headneck, chest, back, abdomen, pelvis, upper extremity, and lower extremity, followed by an. In many cases, this technique is performed as an alternative to percutaneous tendoachilles lengthening, which can permanently weaken the achilles tendon. This video demonstrates a medial gastrocnemius rotation flap for soft tissue coverage of the proximal tibia. Chapter 1 problem analysis in reconstructive surgery. A combined gastrocnemius and soleus flap can lead to a greater incidence of muscle weakness and gait abnormalities. Gastrocnemius flap for proximal leg reconstruction book title. The lateral head of the muscle, compared to the medial, is used more rarely in. Most techniques also place the skin incision on the medial side to avoid this. Medial gastrocnemius muscle flap robert ostrum, md on vimeo. Treatment of common calcaneal tendon rupture using a central. This text provides a comprehensive overview of operative dictations in plastic, aesthetic, and reconstructive surgical procedures, which will serve as a valuable resource for residents, fellows, and practicing surgeons.
Gastrocnemius flap for proximal tibia and knee wound. Pedicled rotational medial and lateral gastrocnemius flaps. The scaffolds including pure pcl scaffolds and pclcs scaffolds containing 10% and 20% cs by weight are successfully fabricated using this technique. Baumann performed multiple transections of the muscularbound portion of the gastrocnemius aponeurosis with or without apo.
This flap can be used with muscle or with muscle and skin. Long posterior flap a burgess technique b bruckner technique 2. A stepbystep manual for the most versatile flaps in reconstructive surgerythis handbook is an introductory guide to harvesting essential workhorse flaps of the torso and upper and lower extremities. Gastrocnemius muscle an overview sciencedirect topics. Following the nahai and mathes classification, the gastrocnemius muscle is a type i muscle with a single dominant vascular pedicle figure 1. Surgical technique zmost common surgical techniques are. Medial achilles tendon island flapa novel technique to. Apr 26, 2020 if the gastrocnemius or the soleus muscle is used alone. Wound coverage techniques for the injured extremity. The gastrocnemius myocutaneous flap used as a over for the exposed knee prosthesis. From 2007 to 2008, 7 patients received gastrocnemius muscle flap surgeries to repair the wounds. Gastrocnemius flap most useful flap for proximal lower leg defects. Outcome of islanded gastrocnemius musculocutaneous flap.
Chapters are grouped into separate sections based on the anatomic region of the flaps. Medial gastrocnemius flap for reconstruction of the extensor. The island pedicle rotation advancement gastrocnemius musculocutaneous flap for complete coverage of the popliteal fossa. Medial gastrocnemius muscle flap robert ostrum, md on vimeo product. Medial gastrocnemius flap in the course of treatment for.
Jan 01, 2020 the gastrocnemius or soleus flap alone is not sufficient. Described very early, it has been proven to be easy to raise and very reliable. Jan 01, 20 the latissimus dorsi free flap, reversed gracilis pedicle flap, distally based vastus lateralis flap, rectus abdominus free flap, perforator flaps 11, 18, and neurofasciocutaneous flaps all have the potential to close large anterior defects, but all are technically demanding procedures and involve a dedicated plastic surgery limb salvage. Medial gastrocnemius flap in the course of treatment for an.
Gastrocnemius flap dr sumer yadav mch plastic surgeon. Aesthetic considerations of the medial gastrocnemius myocutaneous flap. Why the denervated gastrocnemius muscle flap should be encouraged. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft.
Below knee amputationburgess long posterior flap technique. Pain and dysesthesias at the donor site resulting from flap transposition should be expected during the first 6 to 8 weeks and should not be considered a complication. Pearls and tips in coverage of the tibia after a high energy. Most commonly used experimental flaps used in rats, including dorsal skin, flank, epigastric, oblique groin, pectoral, latissimus dorsi, rectus. Purchase orthoplastic techniques for lower extremity reconstruction part 1, an issue of clinics in podiatric medicine and surgery, volume 374 1st edition. Aug 01, 2016 the medial gastrocnemius flap is a standard technique for soft tissue coverage around the knee, and is reportedly safe and reliable with low donor site morbidity. Technique, indications, and results of proximal medial. Use one of two different surgical approaches for the exposure and. This video demonstrates via cadaver dissection the technique for using a medial gastrocnemius flap rotated on a proximal pedicle to cover knee and proximal tibial wounds.
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