V-Y ADVANCEMENT OF MEDIAL GASTROCNEMIUS MUSCLE FLAP FOR REPAIRING SOFT TISSUE DEFECTS IN MIDDLE AND LOWER SEGMENTS OF ANTERIOR TIBIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CUIHaojie ¹ ,  XIAOHaitao ² , HEKuile ¹ , PENGYongli ¹ , BIANZhaohui ¹ , WANGHongye ³

1. The Second Department of Orthopedics, People's Hospital of Renqiu, Renqiu Hebei, 062550, P. R. China;
2. Department of Burn and Plastic Surgery, West China Hospital, Sichuan University;
3. Department of Hand Surgery, Beijing Jishuitan Hospital;

Corresponding author：

XIAOHaitao, Email: xhaitao@163.com

Keywords：

Medial gastrocnemius; Muscle flap; Skin and soft tissue defect of the anterior tibia; Wound repair

DOI：

10.7507/1002-1892.20160228

Video：

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Objective To investigate the effectiveness of V-Y advanced medial gastrocnemius muscle flap to repair soft tissue defects in the middle and lower segments of the anterior tibia. Methods Between March 2008 and March 2014, 8 patients with skin and soft tissue defects of the anterior tibia were treated, including 6 males and 2 females with an average age of 36.2 years (range, 28-47 years). The soft tissue defects located at the left leg in 5 cases and at the right leg in 3 cases. The causes included traffic accident injury in 6 cases, and heavy pound injury in 2 cases. Three cases had simple soft tissue defects, and the disease course was 5 hours, 6 days, and 14 days, respectively. Five cases had soft tissue defects and fractures, including 1 case of Pilon fracture, and 4 cases of middle and distal tibial fracture; open reduction and internal fixation were performed in 3 cases, the implementation of external fixation in 2 cases; 1 case had chronic osteomyelitis at 11 months after operation, and 4 cases had skin necrosis and wound infection at 1 to 2 weeks after operation; the duration was 1-12 months (mean, 3.4 months). The skin and soft tissue defect area was 5.2 cm×2.5 cm to 13.0 cm×5.5 cm. Debridement was given, and vacuum sealing drainage was used in 6 cases, and then V-Y advancement of medial gastrocnemius muscle flap was used to cover the wound. Because of light wound contamination, the wound was repaired by the flap after emergency debridement in 1 case; 1 patient with osteomyelitis underwent flap repair at immediate after sensitive antibiotics use and debridement. The size of medial gastrocnemius muscle flaps ranged from 15 cm×6 cm to 26 cm×15 cm. The donor site was sutured in 3 cases or repaired with skin graft in 5 cases. Results One case had tension blisters in the distal flap, which was cured after symptomatic treatment. The flap and skin graft survived, and primary healing was obtained in the other cases. Seven patients were followed up 6-18 months (mean, 9 months). The texture and appearance of the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 12 to 18 mm (mean, 16 mm). The plantar flexion was weaker than that of normal side, but the patients could normally walk and had normal gait. Conclusion The V-Y advancement of medial gastrocnemius muscle flap is recommendable to repair soft tissue defects in the middle and lower segments of the anterior tibia for the advantages of reliable blood supply, simple operation, high survival rate of the flap, and satisfactory appearance.

Citation： CUIHaojie, XIAOHaitao, HEKuile, PENGYongli, BIANZhaohui, WANGHongye. V-Y ADVANCEMENT OF MEDIAL GASTROCNEMIUS MUSCLE FLAP FOR REPAIRING SOFT TISSUE DEFECTS IN MIDDLE AND LOWER SEGMENTS OF ANTERIOR TIBIA. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1122-1126. doi: 10.7507/1002-1892.20160228 Copy

1.	刘桂花, 陈坤峰, 赵志坚, 等.负压封闭引流配合腓肠肌皮瓣移植治疗胫骨外露创面.中华显微外科杂志, 2011, 34(4):326-327.
2.	侯春林.带血管蒂组织瓣移位手术图解.上海:上海科学技术出版公司, 2006:312-318.
3.	邵新中, 喻伟光, 王巧君, 等.腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用.中华显微外科杂志, 2011, 34(5):373-375.
4.	李志安, 李振武, 姬林松.带远端腓肠神经血管束腓肠肌肌皮瓣推进修复跟部皮肤及跟腱缺损.中国修复重建外科杂志, 2010, 24(10):1279-1280.
5.	葛东江, 任志勇, 魏长月, 等.腓肠血管联合游离皮瓣的解剖及临床应用.中华骨科杂志, 2014, 34(10):1042-1049.
6.	李浩, 梅劲, 季卫平, 等.膝降动脉隐支皮瓣游离移植修复手部软组织缺损.中华显微外科杂志, 2012, 35(2):97-99.
7.	Heymans O, Verhelle N, Peters S, et al. Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest. Burns, 2002, 28(7):674-678.
8.	魏在荣, 孙广峰, 唐修俊, 等.腘窝中间动脉蒂混合供血皮瓣修复儿童腘窝瘢痕挛缩.中国修复重建外科杂志, 2012, 26(8):946-949.
9.	林涧, 陆骅, 郑和平, 等.腘窝直接动脉穿支皮瓣的解剖学基础与临床应用.中华显微外科杂志, 2014, 37(5):480-482.
10.	袁辉宗, 史增元, 尹维刚, 等.小腿前外侧岛状皮瓣修复胫骨外露的解剖研究与临床应用.中华骨科杂志, 2011, 31(5):508-513.
11.	黄继峰, 王增涛, 郭德亮, 等.胫后动脉皮支筋膜皮瓣的解剖及临床应用.中国修复重建外科杂志, 2000, 14(4):217-219.
12.	张子阳, 张文夺, 魏在荣, 等.数字减影血管造影在胫后动脉穿支皮瓣修复足踝部创面中的应用研究.中国修复重建外科杂志, 2015, 29(9):1109-1112.
13.	蔡晓斌, 蓝益南, 沈立锋.改良小腿穿支皮瓣V-Y推进修复踝周创面.中华整形外科杂志, 2016, 32(1):65-67.
14.	朱跃良, 徐永清, 李军, 等.双蒂腓肠肌皮瓣修复跟腱复合缺损的改进及其解剖学依据.中国临床解剖学杂志, 2010, 28(2):225-227.
15.	张龙春, 陈莹, 王鹏, 等.游离腓肠内侧动脉穿支皮瓣修复手部创面.中华手外科杂志, 2015, 31(3):191-194.
16.	唐修俊, 王波, 魏在荣, 等.保留感觉的胫后动脉穿支皮瓣V-Y推进修复踝周创面.中国修复重建外科杂志, 2015, 29(12):1515-1518.
17.	Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2):239-246.
18.	Knopp W, Buchholz J, Muhr G, et al. Negative effects of local tibial muscle flap repair on foot function. Unfallchirurg, 1993, 96(5):229-234.
19.	曾彪, 张惠玲.腓肠肌皮瓣移植治疗小腿严重软组织损伤.江西医药, 2007, 42(8):706.

1. 刘桂花, 陈坤峰, 赵志坚, 等.负压封闭引流配合腓肠肌皮瓣移植治疗胫骨外露创面.中华显微外科杂志, 2011, 34(4):326-327.
2. 侯春林.带血管蒂组织瓣移位手术图解.上海:上海科学技术出版公司, 2006:312-318.
3. 邵新中, 喻伟光, 王巧君, 等.腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用.中华显微外科杂志, 2011, 34(5):373-375.
4. 李志安, 李振武, 姬林松.带远端腓肠神经血管束腓肠肌肌皮瓣推进修复跟部皮肤及跟腱缺损.中国修复重建外科杂志, 2010, 24(10):1279-1280.
5. 葛东江, 任志勇, 魏长月, 等.腓肠血管联合游离皮瓣的解剖及临床应用.中华骨科杂志, 2014, 34(10):1042-1049.
6. 李浩, 梅劲, 季卫平, 等.膝降动脉隐支皮瓣游离移植修复手部软组织缺损.中华显微外科杂志, 2012, 35(2):97-99.
7. Heymans O, Verhelle N, Peters S, et al. Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest. Burns, 2002, 28(7):674-678.
8. 魏在荣, 孙广峰, 唐修俊, 等.腘窝中间动脉蒂混合供血皮瓣修复儿童腘窝瘢痕挛缩.中国修复重建外科杂志, 2012, 26(8):946-949.
9. 林涧, 陆骅, 郑和平, 等.腘窝直接动脉穿支皮瓣的解剖学基础与临床应用.中华显微外科杂志, 2014, 37(5):480-482.
10. 袁辉宗, 史增元, 尹维刚, 等.小腿前外侧岛状皮瓣修复胫骨外露的解剖研究与临床应用.中华骨科杂志, 2011, 31(5):508-513.
11. 黄继峰, 王增涛, 郭德亮, 等.胫后动脉皮支筋膜皮瓣的解剖及临床应用.中国修复重建外科杂志, 2000, 14(4):217-219.
12. 张子阳, 张文夺, 魏在荣, 等.数字减影血管造影在胫后动脉穿支皮瓣修复足踝部创面中的应用研究.中国修复重建外科杂志, 2015, 29(9):1109-1112.
13. 蔡晓斌, 蓝益南, 沈立锋.改良小腿穿支皮瓣V-Y推进修复踝周创面.中华整形外科杂志, 2016, 32(1):65-67.
14. 朱跃良, 徐永清, 李军, 等.双蒂腓肠肌皮瓣修复跟腱复合缺损的改进及其解剖学依据.中国临床解剖学杂志, 2010, 28(2):225-227.
15. 张龙春, 陈莹, 王鹏, 等.游离腓肠内侧动脉穿支皮瓣修复手部创面.中华手外科杂志, 2015, 31(3):191-194.
16. 唐修俊, 王波, 魏在荣, 等.保留感觉的胫后动脉穿支皮瓣V-Y推进修复踝周创面.中国修复重建外科杂志, 2015, 29(12):1515-1518.
17. Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2):239-246.
18. Knopp W, Buchholz J, Muhr G, et al. Negative effects of local tibial muscle flap repair on foot function. Unfallchirurg, 1993, 96(5):229-234.
19. 曾彪, 张惠玲.腓肠肌皮瓣移植治疗小腿严重软组织损伤.江西医药, 2007, 42(8):706.

Chinese Journal of Reparative and Reconstructive Surgery

V-Y ADVANCEMENT OF MEDIAL GASTROCNEMIUS MUSCLE FLAP FOR REPAIRING SOFT TISSUE DEFECTS IN MIDDLE AND LOWER SEGMENTS OF ANTERIOR TIBIA

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