ABSTRACT
Introduction: Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but
has a limitation in covering middle one-third tibial defects. The inferiorly based
hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third
of the leg. The arterial communication between the gastrocnemius muscle heads has
been demonstrated, the consistent location, however, was not studied in large specimens.
Materials and Methods: This study was conducted on sixty specimens of gastrocnemius muscles harvested from
thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius
muscle using radio-opaque contrast with future application of taking one head of muscle
distally based for coverage of middle third defect of tibia. A total of 60 specimens
were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery
ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining
thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350)
given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were
taken, and collaterals between two bellies in lower half were noted and the distance
of collaterals from the muscles top edge was also noted. Results: We found the communications between both bellies of the gastrocnemius muscle in all
specimens in both legs. The mean distance of communications from the upper edge of
the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm
in the right leg, respectively. The mean distance of communications from upper edge
of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78
cm in the left leg. The distal communications between gastrocnemius bellies were not
constant in their location, but all the connections were present in distal 3.79 cm
of raphe. Conclusion: This study supports the future application of inferior-based hemigastrocnemius muscles
flap to cover defects of middle third leg. When distally based hemigastrocnemius flap
is planned roughly 1/3rd of distal attachment or distal 3.79 cm of connection between raphe should be maintained
to preserve the vascular communications between the two bellies.
KEY WORDS
Arterial communication - distally based - gastrocnemius
