The Inferiorly Based Gastrocnemius Muscle Flap: Anatomic Aspects And Clinical Implications

objective to investigate the feasibility of clinical application of inferiorly based gastrocnemius muscle flap(IBGMF). Methods (1)To survey the morphosis and blood supply of gastrocnemius muscle flap on 14cadavers(28 specimens).(2)Two fresh gastrocnemius muscle specimens were warmed and flushed with warm 0.9%NaCl then injecting 0.1%methylene blue through the medial sural artery. The arterial communication between the gastrocnemius were identified by radiography When it was cannulated and injected with iopamidole acid.Two specimens were dissected to find the location of anastomotic and the caliber was measured under microscope. Arteriography was carried out under DSA on one patients to find the location of the lowermost arterial anastomosis between lateral and medial gastrocnemius muscle heads and the anastomosis from soleus. (3)The distally pedicle medial gastrocnemius muscle flap have been used to repair the defects in lower 1/3 limb in two patients. Result ㏕he reverse gastrocnemius muscle flap has multipl- blood supply. It is mainly supplied by anastomosis from soleus. The anastomosis is invariably deteced in the lower fourth. The lowest anastomotic between the gastrocnemius muscle heads is not found at a constant level, it is invariably found in the lower third of the medial head's length. It is said that about upper there-quarters of the medial head can be safely detached from lateralhead in clinical.(2) Dissecting in two fresh specimens, we can find there is a lot of anastomotic arteriole between the muscle heads . After injecting methylene blue through medial sural arteries, the anastomosis of the arterial networks of the heads is depicted, the anastomosis from soleus is also dyed . Arteriograph showed that the medial sural artery arises from the popliteal artery around the keen joint line. There are a lot of anastomotic arteriole can be found between medial and lateral artery and the soleus .(3)The flap was survived in one patient and in another the flap was partially necrosis in distal fifth because of insufficient venous flow. Conclusion The inferiorly based hemigastrocnemius muscle flap for defects of the middle and distal third of the tibia might be both reliable and applicable. Its wide area of rotation, its easy-going dissection, and its reliable vascular pedicle are distinct advantages. Its insufficient venous flow sometimes makes it impossible to use. However, it might be helpful in difficult situation .