The Gastrocnemius Muscle as a Free-Flap Donor Site

We performed an anatomic study on 20 fresh lower limbs. Resin was injected in the popliteal artery. Medial sural artery perforator flaps were sculptured according to anatomic markings. On average, length of flaps was 12.9 cm, width was 7.9 cm; all 38 perforators were musculocutaneous: 1 perforator was always found (on average, 1.9 per flap). All perforators gathered between 7 and 18 cm from the popliteal crease; 34.2% of perforators arose on the midline of the medial head of gastrocnemius muscle; before entering the fascia, the perforator artery diameter was on average 0.5 mm. Two configurations of the intramuscular course of perforators were found. Sixty-six percent of perforators originated from the lateral branch of the medial sural artery, 34% from the medial one. These results improve the anatomic knowledge of the medial posterior calf region and allow us to describe a convenient plan to make flap sculpturing easier.

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The Medial Sural Artery Perforators

Thioné

Valdatta²,

Buoro³

et al. 2004

“…15 However, even this prerequisite might not be essential, because multiple secondary vascular pedicles to the gastrocnemius muscle are not uncommon, 17 and communications between the lateral and medial heads can allow total muscle survival even without the dominant pedicle. 18 Because the muscle remains vascularized by multiple and often separate sources, its subsequent use as a local muscle flap after elevation of the overlying perforator flap not only is theoretically plausible as Cavadas et al suggested, 3 but now has been proven to be a clinical reality (Figs 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

Sequential Use of a True Perforator Flap and Its Corresponding Muscle Flap

Hallock

2003

A true perforator flap completely spares the underlying muscle that was previously required as essentially a passive carrier of that musculocutaneous unit. Thus, a perforator flap and its related muscle can now be simultaneously transferred as independent but conjoint flaps based on the same source pedicle, or sometimes also in a metachronous fashion if the requisite source vessels remain intact. The latter principle proved feasible after failure of 2 medial sural perforator flaps that were subsequently successfully replaced by a conventional medial gastrocnemius muscle flap. At least theoretically, depending on the extent of intramuscular dissection, another advantage that can be applied to all perforator flaps is that the muscle can be held in reserve for sequential use as necessary.

“…Since this flap is already relatively thin, the risks of microdissection for thinning can be avoided. 13 Because multiple secondary vascular pedicles to the gastrocnemius muscle are not uncommon, 16 and communications between the lateral and medial heads can allow total muscle survival even without retention of the dominant medial sural pedicle, 17 necrosis of the muscle would be an unexpected sequela. This opinion is corroborated by the fact that metachronous or sequential use of the medial gastrocnemius muscle as a second or back-up flap is still possible after harvest of this perforator flap.…”

Section: Hallock and Sanomentioning

confidence: 99%

The Medial SuralMEDIAL GASTROCNEMIUS Perforator Free Flap

Hallock

Sano²

2004

The medial sural MEDIAL GASTROCNEMIUS perforator flap is a potentially large, thin cutaneous flap that encompasses the calf skin territory. Its medial sural vascular pedicle has a long leash of large caliber that simplifies microanastomoses when used as a free flap. Because the identification of the requisite perforators and their subsequent intramuscular dissection is facilitated with the patient in a prone position, this can be an "ideal" skin free flap for the posterior aspect of the body. This is especially true for the lower limb where all surgical morbidity could then be restricted to the ipsilateral extremity. This approach has been used in 5 clinical cases, with success except once when the flap was aborted as a result of anatomic anomalies, which is always a concern with muscle perforator flaps.