Gastrocnemius Muscle Flap vs. Proximally Based Sural Fasciocutaneous Flap for Coverage of Knee, Proximal and Middle Third of Leg: A Comparative Study of 22 Cases in a Tertiary Level Hospital

Abstract

Introduction: A high pace of urbanization and improvised high-velocity motor vehicles are the leading factors for high energy lower limbs trauma in a middle-income country, Bangladesh resulting in a common compound fracture and dislocation at the level of knee; the proximal and middle third of the leg in the salvageable limb. Among the coverage options, gastrocnemius muscle flap (GMF) and proximally based sural fasciocutaneous flap (PBSFC flap) were used for a long period to meet the good reconstructive goals. Aims and objectives: The study aims to compare between gastrocnemius muscle flaps and proximally based sural artery fasciocutaneous flaps for coverage of soft tissue defect on proximal and middle third of leg with the exposed tibia and/or knee joint in terms of operating time, flap viability and its complications, donor site morbidity, time taken for bone healing. Methods and materials: This study is a retrospective study of 22 cases of those who came with soft tissue defects on knee and proximal and middle third of leg requiring flap coverage in Rajshahi Medical College Hospital from August 2019 to July 2021. Here we harvested medial gastrocnemius muscle flap for coverage of knee and proximal third of the leg and PBSFC flap based on median sural artery was done for the defect on knee to proximal two third of leg. All the donor sites of PBSFC flaps were covered by split thickness skin graft, whereas, in case of GMF, the donor site was tried for direct closure. Results and discussion: 13 GMF and 09 PBSFC flap were done in the study period. All collected data were analyzed in GMF group and PBSFC flap group and made the comparison between two groups by standardized analytic testing tools. Conclusion: In comparisons of two different flaps of the study, none was superior in terms of survivability of the flap, rate wound infection control, bone healing.