Bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing Achilles tendon and overlying skin defect: the anatomic basis and clinical application.
OBJECTIVE
To study the anatomic basis of the bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing the composite Achilles tendon defect.


METHODS
The pedicle anatomy of the bi-pedicled V-Y gastrocnemius myocutaneous flap was examined on 30 cadaver specimens. The sliding distances of the flap were measured at different knee flexion degrees. The bi-pedicled V-Y gastrocnemius myocutaneous flap was applied in 12 cases of Achilles tendon defect with simultaneous skin and soft tissue defect.


RESULTS
The sural arteries could be classified into four types. After cutting off the gastrocnemius origin with a "Z-shaped" incision, the sliding distance of the flap reached (3.7+/-0.5) cm when the knee flexed 0 degree, (4.9+/-0.7)cm when the knee flexed 30 degree,(6.7+/-0.7) cm when the knee flexed 60 degree and (9.2+/-0.9) cm when the knee flexed 90 degree. All the defects healed. The patients recovered ambulation with satisfactory knee and ankle function. The follow-up was 4 months-12 years.


CONCLUSIONS
Different sural artery types should be noticed during the harvest of the bi-pedicled-V-Y gastrocnemius myocutaneous flap. With 90 degree knee flexion, this flap is suitable for one-stage repair of composite Achilles tendon defect within 9.2 cm+/-0.9 cm.
Xu
Yong-qing
YQ
Orthopedic Center, Kunming General Hospital of Chengdu Military Command, Kunming 650032, China. xuyongqingkm@163.net
Zhu
Yue-liang
YL
Ysng
Jun
J
Li
Jun
J
Ding
Jing
J
Lu
Sheng
S
Liu
Yong
Y
D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply; D013708:Tendon Injuries / Q000601:surgery*