Anatomic Basis of the Gastrocnemius Perforator-Based Flap

Abstract

The gastrocnemius muscle is rarely considered today as a musculocutaneous flap. Yet, the posterior calf skin by itself can still be used to advantage as a source of local or perhaps free flaps. Fascial perforators in this region were reexamined in an anatomic study in 10 fresh cadaveric specimens to investigate the possibility of a gastrocnemius muscle perforator-based flap. At least two substantive perforators were found in all limbs, and there was always one overlying the medial gastrocnemius muscle (overall mean, 4.0 +/- 1.8 perforators; range, 2-7 perforators). The origin of these perforators in any given specimen was most commonly as a secondary branch from the medial or lateral sural arteries alone (60%), from the median sural artery as a direct cutaneous branch alone (10%), or from either of the muscle pedicles and/or the median sural artery (30%). Thus, in 90% of limbs, the potential for elevating a gastrocnemius perforator-based flap exists without the need for any muscle sacrifice. Otherwise, a more traditional posterior calf fasciocutaneous flap was possible. Other deeper intramuscular collaterals were also identified so that sequential use of the muscle as a separate flap does not seem to be compromised.

Microsurgical nonmicrovascular flaps in forearm and hand reconstruction

“…The local flaps were used as transposition, rotation, or advancement flaps, based on perforators from the radial (RA)-37, ulnar (UA)-16 or posterior interosseous (PIOA)-14 artery, and regional flaps as distally pedicled flaps. The pedicled flaps were based only on perforators from the RA (28) or the PIOA (20) and were fasciocutaneous in 33 cases and fasciosubcutaneous in 15 cases. A radial bone segment was included in 5 fasciosubcutaneous flaps.…”

“…40 Another disadvantage of perforator flaps is the variability in the position and size of the perforator vessels. 20 In the attempt to improve the results, the importance of preoperative planning by using various methods was proved. A lot of such methods were developed, as Doppler ultrasound, 53 Doppler flowmetry, 54 magnetic resonance imaging, 55 thermography, 56 color-flow duplex scanning, 57 scanning laser Doppler imaging, 58 but they could be either imprecise or limited by the cost or competence of the technician.…”

Gastrocnaemius-propeller extended miocutanous flap: A new chimaeric flap for soft tissue reconstruction of the knee

“…15 More recently, Hallock pointed out the availability of this pedicled flap to reach, as far as the medial gastrocnaemius muscle flap itself was concerned, the knee and upper third of the leg defects. 17 Lately, several anatomical studies have been carried out to define the number, size and location of these perforators.…”

“The Practical Perforator Flap”: the sural artery flap for lower extremity soft tissue reconstruction in wounds of war

“…Others have described the anatomy of the perforating vessels that supply the fascia and skin of the posterior calf in more detail [4][5][6]. Hallock [4] described that successful preparation of a medial sural artery perforator flap was possible in 90% of cases.…”