CC BY-NC-ND 4.0 · Indian J Plast Surg 2016; 49(01): 53-58
DOI: 10.4103/0970-0358.182240
Original Article
Association of Plastic Surgeons of India

Cadaveric study using radio-opaque contrast to determine arterial communication between the two bellies of gastrocnemius muscles

Pawan Agarwal
Department of Surgery, Plastic Surgery Unit, N.S.C.B. Government Medical College, Jabalpur, Madhya Pradesh, India
,
K. L. Gupta
Department of Surgery, Plastic Surgery Unit, N.S.C.B. Government Medical College, Jabalpur, Madhya Pradesh, India
,
P. Yadav
Department of Surgery, Plastic Surgery Unit, N.S.C.B. Government Medical College, Jabalpur, Madhya Pradesh, India
,
Dhananjaya Sharma
Department of Surgery, Plastic Surgery Unit, N.S.C.B. Government Medical College, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Further Information

Address for correspondence:

Dr. Pawan Agarwal
292/293, Napier Town, Jabalpur - 482 001, Madhya Pradesh
India   

Publication History

Publication Date:
13 August 2019 (online)

 

ABSTRACT

Introduction: Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but has a limitation in covering middle one-third tibial defects. The inferiorly based hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third of the leg. The arterial communication between the gastrocnemius muscle heads has been demonstrated, the consistent location, however, was not studied in large specimens. Materials and Methods: This study was conducted on sixty specimens of gastrocnemius muscles harvested from thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius muscle using radio-opaque contrast with future application of taking one head of muscle distally based for coverage of middle third defect of tibia. A total of 60 specimens were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were taken, and collaterals between two bellies in lower half were noted and the distance of collaterals from the muscles top edge was also noted. Results: We found the communications between both bellies of the gastrocnemius muscle in all specimens in both legs. The mean distance of communications from the upper edge of the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm in the right leg, respectively. The mean distance of communications from upper edge of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78 cm in the left leg. The distal communications between gastrocnemius bellies were not constant in their location, but all the connections were present in distal 3.79 cm of raphe. Conclusion: This study supports the future application of inferior-based hemigastrocnemius muscles flap to cover defects of middle third leg. When distally based hemigastrocnemius flap is planned roughly 1/3rd of distal attachment or distal 3.79 cm of connection between raphe should be maintained to preserve the vascular communications between the two bellies.


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Conflicts of interest

There are no conflicts of interest.

  • REFERENCES

  • 1 Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg 2002; 110: 1673-9
  • 2 Taylor GI, Pan WR. Angiosomes of the leg: Anatomic study and clinical implications. Plast Reconstr Surg 1998; 102: 599-616
  • 3 Bashir AH. Inferiorly-based gastrocnemius muscle flap in the treatment of war wounds of the middle and lower third of the leg. Br J Plast Surg 1983; 36: 307-9
  • 4 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The venous communication between the gastrocnemius muscle heads. Plast Reconstr Surg 2000; 105: 1357-60
  • 5 Mathes SJ, Nahai F. Reconstructive Surgery: Principles, Anatomy and Technique. 1st ed.. New York: Churchill Livingstone; 1997: p. 1391-418
  • 6 Atchabahian A, Masquelet AC. The distally based medial gastrocnemius flap: Case report and anatomic study. Plast Reconstr Surg 1996; 98: 1253-7
  • 7 Cormack GC, Lamberty BG. The Arterial Anatomy of Skin Flaps. 2nd ed.. New York:: Churchill Livingstone; 1994: p. 464-6
  • 8 Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994; 93: 1012-20
  • 9 Rooks MD. Coverage problems of the foot and ankle. Orthop Clin North Am 1989; 20: 723-36
  • 10 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78: 285-92
  • 11 Suominen S, Asko-Seljavaara S. Free flap failures. Microsurgery 1995; 16: 396-9
  • 12 Acland RD. Refinements in lower extremity free flap surgery. Clin Plast Surg 1990; 17: 733-44
  • 13 Arnold PG, Yugueros P, Hanssen AD. Muscle flaps in osteomyelitis of the lower extremity: A 20-year account. Plast Reconstr Surg 1999; 104: 107-10
  • 14 Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf AW, Musharafieh RS. Distally based sural fasciocutaneous cross-leg flap: A new application of an old procedure. Plast Reconstr Surg 2003; 111: 1470-4
  • 15 Ebraheim NA, Madsen TD, Humpherys B. The tibialis anterior used as a local muscle flap over the tibia after soft tissue loss. J Trauma 2003; 55: 959-61
  • 16 Mamaloukakis SC, Assimomitis CM, Tsetsonis CH, Stavrianos SD, Kokkalis GA. Gastrocnemius muscle flap of both heads on a single vascular pedicle. Scand J Plast Reconstr Surg Hand Surg 2006; 40: 120-3
  • 17 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The arterial communication between the gastrocnemius muscle heads: A fresh cadaveric study and clinical implications. Plast Reconstr Surg 2000; 105: 94-8
  • 18 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The inferiorly based gastrocnemius muscle flap: Anatomic aspects. Plast Reconstr Surg 2000; 106: 1312-5
  • 19 Kishk T. Reconstruction of the middle third of the leg by distally based hemi-gastrocnemius muscle flap. Menoufiya Med J 2008; 2: 215-22

Address for correspondence:

Dr. Pawan Agarwal
292/293, Napier Town, Jabalpur - 482 001, Madhya Pradesh
India   

  • REFERENCES

  • 1 Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg 2002; 110: 1673-9
  • 2 Taylor GI, Pan WR. Angiosomes of the leg: Anatomic study and clinical implications. Plast Reconstr Surg 1998; 102: 599-616
  • 3 Bashir AH. Inferiorly-based gastrocnemius muscle flap in the treatment of war wounds of the middle and lower third of the leg. Br J Plast Surg 1983; 36: 307-9
  • 4 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The venous communication between the gastrocnemius muscle heads. Plast Reconstr Surg 2000; 105: 1357-60
  • 5 Mathes SJ, Nahai F. Reconstructive Surgery: Principles, Anatomy and Technique. 1st ed.. New York: Churchill Livingstone; 1997: p. 1391-418
  • 6 Atchabahian A, Masquelet AC. The distally based medial gastrocnemius flap: Case report and anatomic study. Plast Reconstr Surg 1996; 98: 1253-7
  • 7 Cormack GC, Lamberty BG. The Arterial Anatomy of Skin Flaps. 2nd ed.. New York:: Churchill Livingstone; 1994: p. 464-6
  • 8 Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994; 93: 1012-20
  • 9 Rooks MD. Coverage problems of the foot and ankle. Orthop Clin North Am 1989; 20: 723-36
  • 10 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78: 285-92
  • 11 Suominen S, Asko-Seljavaara S. Free flap failures. Microsurgery 1995; 16: 396-9
  • 12 Acland RD. Refinements in lower extremity free flap surgery. Clin Plast Surg 1990; 17: 733-44
  • 13 Arnold PG, Yugueros P, Hanssen AD. Muscle flaps in osteomyelitis of the lower extremity: A 20-year account. Plast Reconstr Surg 1999; 104: 107-10
  • 14 Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf AW, Musharafieh RS. Distally based sural fasciocutaneous cross-leg flap: A new application of an old procedure. Plast Reconstr Surg 2003; 111: 1470-4
  • 15 Ebraheim NA, Madsen TD, Humpherys B. The tibialis anterior used as a local muscle flap over the tibia after soft tissue loss. J Trauma 2003; 55: 959-61
  • 16 Mamaloukakis SC, Assimomitis CM, Tsetsonis CH, Stavrianos SD, Kokkalis GA. Gastrocnemius muscle flap of both heads on a single vascular pedicle. Scand J Plast Reconstr Surg Hand Surg 2006; 40: 120-3
  • 17 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The arterial communication between the gastrocnemius muscle heads: A fresh cadaveric study and clinical implications. Plast Reconstr Surg 2000; 105: 94-8
  • 18 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The inferiorly based gastrocnemius muscle flap: Anatomic aspects. Plast Reconstr Surg 2000; 106: 1312-5
  • 19 Kishk T. Reconstruction of the middle third of the leg by distally based hemi-gastrocnemius muscle flap. Menoufiya Med J 2008; 2: 215-22