Reconstruction of a lower extremity soft-tissue defect using the gastrocnemius musculoadipofascial flap

Use of the gastrocnemius as either a muscle or musculocutaneous flap has proved to be effective in the management of knee and lower leg soft-tissue defects because of its reliable constant vascular pedicle and ease of procedure with little or no functional deficit. As a muscle flap, the volume of the distal part of the muscle for coverage is small, and is even smaller when accompanied by posttraumatic disuse atrophy. Although there have been many modifications to increase the arc of rotation and dimensions of the muscle flap, the disadvantage is the skin graft on the flap donor site and the resulting deformity of the leg contour. Also, clinical limitations occur when the defect size is extensive or there is an inadequate arc of rotation or dimension. The authors present their clinical application of a gastrocnemius muscle flap with a distal adipofascial flap as a useful alternative for various sizes and types of defects. Between 1999 and 2000, gastrocnemius adipofascial flaps were used in 7 patients with various types of defects. This form of musculoadipofascial flap has not yet been described in the known literature. In the authors' opinion, this procedure is a valuable extension of local flap procedures in reconstructing relatively large defects in the region of the knee and lower extremity.