The Functional Free Innervated Medial Gastrocnemius Flap

Abstract

Background The functional free innervated medial gastrocnemius flap has been described in four previous articles for the management of foot drop, Volkmann contracture, and upper limb muscle defects. We expand the indications by describing the use of free innervated medial gastrocnemius musculocutaneous flap in functional reconstruction of the tongue and upper limb musculature.

Methods The right medial gastrocnemius muscles were raised as myocutaneous flaps in six patients. These flaps were elevated in the supine position and the flaps included a motor nerve from the sciatic nerve and a sensory nerve from the sural nerve. The average size of flap was 15 × 8 cm.

Results The flaps were transferred successfully with no flap loss and showed consistent reinnervation during follow-up. In particular, all patients who underwent tongue reconstruction exhibited intelligible speech and returned to full oral diet with no aspiration. In patients who underwent upper limb muscle reconstructions, there was moderate to full restoration of power. All donor sites exhibited excellent symmetry in both power and appearance to the contralateral calf.

Conclusions To our knowledge, this study is the first to describe the use of the innervated medial gastrocnemius free flap in the reconstruction of the tongue and deltoid. The advantages of this flap include its thin reliable skin paddle, strong bulky bipennate muscle, and low donor site morbidity.

Keywords

medial gastrocnemius - musculocutaneous - tongue reconstruction

• References

• 1 Chen SL, Yu CC, Chang MC, Deng SC, Wu YS, Chen TM. Medial sural artery perforator flap for intraoral reconstruction following cancer ablation. Ann Plast Surg 2008; 61 (3) 274-279
• 2 de la Fuente TP, González I, Calderón-Muñoz F. The role of medial gastrocnemius free flap in coverage of ischial pressure sore in paraplegic patients. Int J Surg 2008; 6 (6) e72-e76
• 3 Jones JW. Reinnervated medial gastrocnemius free flap for closure of a recurrent ischial pressure sore: case report. J Reconstr Microsurg 2002; 18 (5) 397-400
• 4 Feldman JJ, Cohen BE, May Jr JW. The medial gastrocnemius myocutaneous flap. Plast Reconstr Surg 1978; 61 (4) 531-539
• 5 Katsumura T, Hirase Y, Fukumoto K, Yamaguchi T. Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type III open fracture. J Reconstr Microsurg 2013; 29 (2) 113-116
• 6 Ninković M, Sućur D, Starović B, Marković S. A new approach to persistent traumatic peroneal nerve palsy. Br J Plast Surg 1994; 47 (3) 185-189
• 7 Ninković M, Ninković M. Neuromusculotendinous transfer: an original surgical concept for the treatment of drop foot with long-term follow-up. Plast Reconstr Surg 2013; 132 (3) 438e-445e
• 8 Liu XY, Ge BF, Win YM, Jing H. Free medial gastrocnemius myocutaneous flap transfer with neurovascular anastomosis to treat Volkmann's contracture of the forearm. Br J Plast Surg 1992; 45 (1) 6-8
• 9 Potparić Z, Colen LB, Sućur D, Carwell GR, Carraway JH. The gastrocnemius muscle as a free-flap donor site. Plast Reconstr Surg 1995; 95 (7) 1245-1252
• 10 Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction—a systematic review. Oral Oncol 2013; 49 (6) 507-524
• 11 Calabrese L, Saito A, Navach V , et al. Tongue reconstruction with the gracilis myocutaneous free flap. Microsurgery 2011; 31 (5) 355-359
• 12 Leymarie N, Karsenti G, Sarfati B, Rimareix F, Kolb F. Modification of flap design for total mobile tongue reconstruction using a sensitive antero-lateral thigh flap. J Plast Reconstr Aesthet Surg 2012; 65 (7) e169-e174
• 13 Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg 1986; 78 (1) 1-8
• 14 Urken ML, Moscoso JF, Lawson W, Biller HF. A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy. Arch Otolaryngol Head Neck Surg 1994; 120 (6) 589-601
• 15 Rihani J, Lee MR, Lee T, Ducic Y. Flap selection and functional outcomes in total glossectomy with laryngeal preservation. Otolaryngol Head Neck Surg 2013; 149 (4) 547-553
• 16 Kao HK, Chang KP, Chen YA, Wei FC, Cheng MH. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg 2010; 125 (4) 1135-1145
• 17 Wechselberger G, Schoeller T, Bauer T , et al. Surgical technique and clinical application of the transverse gracilismyocutaneous free flap. Br J Plast Surg 2001; 54 (5) 423-427
• 18 Lyos AT, Evans GR, Perez D, Schusterman MA. Tongue reconstruction: outcomes with the rectus abdominis flap. Plast Reconstr Surg 1999; 103 (2) 442-447 , discussion 448–449
• 19 Nakatsuka T, Harii K, Yamada A, Asato H, Ebihara S. Versatility of a free inferior rectus abdominis flap for head and neck reconstruction: analysis of 200 cases. Plast Reconstr Surg 1994; 93 (4) 762-769
• 20 Sadove RC, Vasconez HC, Arthur KR , et al. Immediate closure of traumatic upper arm and forearm injuries with the latissimus dorsi island myocutaneous pedicle flap. Plast Reconstr Surg 1991; 88: 115-120
• 21 Ihara K, Doi K, Shigetomi M, Kawai S. Tensor fasciae latae flap: long-term follow-up and refinement of its application. Plast Reconstr Surg 2003; 112 (2) 595-596
• 22 Manktelow RT, Zuker RM. The principles of functioning muscle transplantation: applications to the upper arm. Ann Plast Surg 1989; 22 (4) 275-282
• 23 Fan C, Jiang P, Fu L, Cai P, Sun L, Zeng B. Functional reconstruction of traumatic loss of flexors in forearm with gastrocnemius myocutaneous flap transfer. Microsurgery 2008; 28 (1) 71-75