The segmental gastrocnemius muscles' flap: a cadaveric study

Abstract

The aim of this study was to evaluate the feasibility of splitting each head of the gastrocnemius muscle into two segments. This prospective study was conducted on 35 fresh cadavers with injection of radio-opaque contrast material in the popliteal artery. Seventy medial gastrocnemius and 70 lateral gastrocnemius muscle specimens were obtained. Gastrocnemius intramuscular arterial anatomy was analysed by using the digital X-ray technique. The most common vascular pattern found in this study was both bellies supplied by individual sural arteries, which shows distal bifurcation. The medial sural artery always showed bifurcation in the medial gastrocnemius muscle in both lower limbs, whereas this bifurcation of the lateral sural artery was present in only 87% cases and 13% of cases showed a single lateral sural artery without bifurcation in the lateral gastrocnemius muscle. The mean pedicle length of the medial sural artery in the right lower limb was 2.1 cm, and in left lower limb 2.3 cm. The mean pedicle length of the lateral sural artery in the right lower limb was 2.44 cm and in the left lower limb 3.21 cm. The segmental vascular pattern of the medial belly of the gastrocnemius is constant, and, thus, it can be divided safely for coverage of multiple wound defects around the knee joint. The short length of the median sural artery allows for high division of the medial gastrocnemius muscle belly. The segmental vascular anatomy is not constant in the lateral belly of the gastrocnemius muscle and, hence, division of the lateral belly is not advocated without prior preoperative colour Doppler.