Evaluation of the versatility of superiorly based pedicled gastrocnemius myo- or myo-cutaneous flap, in upper leg defects after trauma or tumor excision: which is better?

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Abstract

Purposes
The current study aimed to focus on the versatility of the superiorly based pedicled gastrocnemius muscle flap or myocutaneous flap, either medial or lateral head, in upper-leg defects after trauma or tumor excision and the importance of these flaps to improve bone healing in trauma and to ensure an adequate safety margin in malignant tumors with minimal complications.
Patients and methods
A prospective, randomized trial was conducted on 27 patients suffering from upper-leg defects after trauma or tumor excision to compare postoperative outcomes, especially bone healing, using superiorly based pedicled gastrocnemius muscle flap covered by a split thierch skin graft [group A; 14 (51.8%)] against myocutaneous flap [group B, 13 (48.2%) cases], either medial or lateral head. Postoperative follow-up was for 6 months.
Results
Rapid healing of the tibial fracture was noticed in 8 (57.1%) cases in group A and in 8 (61.5%) cases in group B within 2 weeks after surgery, and there was no flap loss apart from partial skin loss, minor hematomas, or infections, all were noticed significantly more in group A [5 (35.7%), 6 (42.9%), and 4 (28.6%) cases, respectively], compared with group B [1 (8%), 2 (15.4%), and 1 (8%) cases, respectively; < 0.05].
Conclusion
Both gastrocnemius myocutaneous and myocutaneous flaps for upper-leg reconstruction are considered as a reliable option to ensure a good safety margin in malignant tumor cases and to help bone healing in trauma cases, and myocutaneous flaps are safer, with no redo and lesser postoperative complications.

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