Myocutaneous gastrocnemius flap for thigh wound coverage.

Abstract

Abstract:

Introduction: Injuries to the distal third of the thigh and upper knee area are usually associated with a linear incision prior to¬ such a knee arthroplasty. Options for reconstruction of this area include saphenous, helix, anteromedial (AMT) and anterolateral reverse thigh (ALT) flaps. (1). Traditionally the
gastrocnemius flap has been used for coverage of knee wounds, however,
at the Department of Plastic Surgery, BJG Medical College and Sassoon
Hospital, Pune, India, it has been used in its myocutaneous variant successfully for coverage of defects up to 20 cm above the knee joint, including the middle and distal third of the thigh. (2).

Objectives: To demonstrate that the musculocutaneous gastrocnemius flap is an option for wound closure at the distal thigh when coverage cannot be achieved with microsurgical techniques.

Case report: A 36-year-old male patient, victim of a motorcycle accident which resulted in a closed fracture of the left femur distal diaphysis, and he went to a private hospital. The trauma department performed internal fixation of the injury by placing an osteosynthesis plate, for which they made two incisions, one anterior and one anterolateral at the skin level of the
middle and distal third of the left thigh, presenting cyanosis and subsequent necrosis of the skin and deep tissues in the immediate postoperative period, exposing the fracture site and the osteosynthesis plate. Therefore, the traumatology service performed surgical cleaning and placement of negative
pressure system. The patient was evaluated by the plastic surgery service, which performed surgical cleaning, wound exploration and repositioning of the negative pressure system. After 48 hours, due to the lack of microsurgical instruments, it was decided to cover the patient with a gastrocnemius myocutaneous flap.

Conclusions: The myocutaneous gastrocnemius flap is an option for
wound coverage in the distal third of the thigh, when perforating arteries of local flaps have been sacrificed in this region