title: Lateral gastrocnemius myocutaneous flap transposition to the midlateral femur: extending the arc of rotation.
abstract: We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.
authors.affiliation: From the *Department of Surgery, †Department of Surgery, Division of Plastic and Reconstructive Surgery, and ‡Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA.
authors.forename: Rishi Raj
authors.initials: RR
authors.lastname: Agarwal
authors.forename: Kevin
authors.initials: K
authors.lastname: Broder
authors.forename: Anna
authors.initials: A
authors.lastname: Kulidjian
authors.forename: Richard
authors.initials: R
authors.lastname: Bodor
mesh_terms: D001858:Bone Nails / Q000009:adverse effects; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005269:Femur / Q000293:injuries / Q000528:radiation effects / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D064827:Myocutaneous Flap; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods*