Medial gastrocnemius flap: infection control in megaprostheses

Medial gastrocnemius flaps are commonly employed in conjunction with endoprosthesis implantations for the management of malignant tumors affecting the proximal segment of the tibia. This study aimed to evaluate the effect of the routine transfer of the muscle on the incidence of infections within the surgical field.

Forty-three patients presenting with a suspected malignant tumor in the proximal segment of the cruris underwent evaluation at our hospital. The enrolled patients were stratified into two cohorts. Patients in Group 1 (n = 16) underwent a combined procedure involving a medial gastrocnemius flap and a megaprosthesis, whereas patients in Group 2 (n = 17) did not undergo flap surgery.

In Group 1, osteosarcoma (OS) was diagnosed in seven patients (43%). Subsequently, oncologic resection with a wide margin was performed on the affected bone region, resulting in an average defect length of mean 12.81 ± 5.05 cm. The patients in this group were followed-up for an average duration of 34.06 ± 13.21 months. Similarly, in Group 2, OS was present in seven patients (41.17%), and they underwent identical oncologic resection procedures. The mean defect length in Group 2 was measured at mean 14.12 ± 4.54 cm. The average follow-up period for patients in Group 2 was 30.41 ± 12.06 months.

Within Group 1, four patients (25%) experienced infections within the surgical site, while within Group 2, five patients (29.4%) exhibited such infections (p > 0.05). The utilization of megaprostheses in osseous defect repair, either alone or in combination with gastrocnemius flaps, did not yield statistically significant differences in infection rates.