Year Book: Why the Denervated Gastrocnemius Muscle Flap Should Be Encouraged

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Pico, R. Luscher, NJ. Rometsch, M. de, Roche R. Abstract/Commentary: 1992 Year Book of Orthopedics. Article 9-27. Original Article: Ann Plast Surg. 1991. 26. pp 312-324. Background.--The superiorly based, denervated gastrocnemius muscle flap provides an aesthetically excellent and functionally good cover for defects of the upper third of the calf, including the knee, and lower third of the thigh. The stability of wound closure and condition of the involved bone were analyzed during a 1-year follow-up of patients undergoing coverage of a soft tissue defect with a gastrocnemius flap. Methods.--Forty-one consecutive muscle and musculocutaneous gastrocnemius flaps were assessed. Thirty-six patients (88%) were available for reexamination. Mean follow-up was 36 months, with a minimum of 12 months. Results.--At examination all skin defects and the incidental concomitant osteomyelitis had healed completely. However, 40% of the patients needed second operations. Half had a functional deficiency, and one fifth had lost sensation in some areas. After surgery with musculocutaneous flaps, all of the patients had sensory loss of the saphenous nerve. Peripheral edema also occurred more often than after surgery with a simple muscle flap. Muscle flaps with residual innervation had more secondary wound breakdown and more contraction pain because of spasms.