The medial gastrocnemius myocutaneous flap.

Our experience with the medial gastrocnemius myocutaneous flap is presented. We have found it to be a reliable flap which can be transferred in one stage to solve difficult coverage problems about the knee and upper leg.     

The versatile gastrocnemius myocutaneous flap.

The medial and lateral gastrocnemius myocutaneous flaps are described. Their usefulness, as direct flaps without a delay, in reconstruction of the lower extremity is described. In our practice, this flap has supplanted the cross-leg flap for most reconstructions in the lower extremity.     

The medial gastrocnemius muscle flap: a local free flap

A new application of the medial gastrocnemius muscle flap has been described. Lengthening of the sural vascular pedicle was obtained using interposition vein grafts. This allowed coverage of a larger defect than that which could have been obtained with the tethered muscle and without further insult to the already disturbed lower extremity anatomy. The principle of pedicle lengthening can be used to increase the arc of rotation of various other muscle, myocutaneous, skin, or bone flaps and thereby increase their usefulness.     

The scrotal myocutaneous flap

The scrotum is a thermoregulatory, well-vascularized structure formed by skin and nonstriated muscle with unique elastic properties. This makes it an ideal source of tissue coverage for problem wounds in its vicinity. Two patients in which scrotal musculocutaneous flaps were used are reported: one, a paraplegic, with a recurrent ischioperineal decubitus ulcer, and another with an ulcer of the penis with exposed Dacron graft previously placed to treat Peyronie's disease. After reviewing the anatomy of the scrotum and the existent literature, we studied scrotal vascularity in a fresh specimen by transillumination. Based on our experience, we conclude that this flap is easy to perform, reliable, and very useful for wounds around the perineal region.     

Coverage of wounds in the distal lower leg by advancement of an enlarged medial gastrocnemius skin flap

Advancement of a medial gastrocnemius flap is a new technique in treating skin defects of the lower third of the lower leg, including that at the anteromedial aspect of the distal portion of the lower leg. Satisfactory results have been obtained in two clinical cases using this technique. In this modified technique, the size of the flap is enlarged, the origin of the medial head of the gastrocnemius is severed so that the island myocutaneous flap may be advanced 8 to 9 cm distally, and good blood supply to the flap is also maintained. In the authors' opinion, this method is a new approach that is simple, easy, safe, and reliable in treating skin defects of the lower leg.     

The vastus lateralis myocutaneous flap

Four case reports of decubiti treated with vastus lateralis myocutaneous flaps are presented. The operative technique is described in detail. This method, closing the donor site primarily over Hemovac drains and eliminating the use of skin grafts, can be used to cover defects in a variety of locations.     

Uses of the rectus femoris myocutaneous flap.

The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.     

Vascular considerations in the use of a latissimus dorsi myocutaneous flap after a mastectomy with an axillary dissection.

Is an intact thoracodorsal vascular pedicle necessary for clinical rotation of a latissimus dorsi myocutaneous flap? Our laboratory and clinical experiences indicate that it is not necessary. These are described herein.     

Pectoralis major myocutaneous flap for hypopharyngeal reconstruction

The reconstruction of total or subtotal defects after surgical treatment for hypopharyngeal cancer is a challenging problem in head and neck surgery. The authors discuss reconstructive surgery performed in 37 patients affected by advanced hypopharyngeal cancer using the pectoralis major myocutaneous flap. In 22 cases of total pharyngolaryngectomy, the reconstructive procedure originally proposed by the authors was based on the use of a pectoralis major myocutaneous flap directly sutured to the pharyngeal and esophageal stumps and the prevertebral fascia, which eventually represented the posterior wall of the neohypopharynx. In 15 cases of subtotal pharyngolaryngectomy, the posterior wall of the neohypopharynx consisted of a residual strip of pharyngeal mucosa. In each patient, removal of the tumor and reconstruction were performed during the same operation, with only a few complications. Neither flap necrosis nor strictures were encountered; five patients had pharyngeal fistula and one patient died because of massive pneumonia. Although the use of microvascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for hypopharyngeal reconstruction, thanks to its feasibility and low complication rate. The other reconstructive options require surgical transgression of the abdomen and/or thorax in patients affected by malnutrition and other chronic systemic disorders.     

The free latissimus dorsi myocutaneous flap.

The general anatomy and the detailed vascular anatomy of the latissimus dorsi myocutaneous flap is described, and its use as a free flap is illustrated. The speed and ease with which it can be raised, its long vascular pedicle, the large diameter of the donor vessels, and the potentially large size of the flap are emphasized.