The Telescopic Chimeric Medial Gastrocnemius - Medial Sural Artery Perforator (G-MSAP) Flap for Open Mid-Tibial Fractures.

Abstract

Lower limb reconstruction options of the middle and distal third of the leg presents a challenge for the reconstructive surgeon. V-Y or propeller flaps are useful for smaller defects while hemi-soleus flaps have limited use and reliability but for the medium-to-large defects, free tissue transfers are the norm but these present their own co-morbidities. One reason for this is that open fractures of the lower leg often require soft tissue of sufficient volume to fill in the defect. The use of the pedicled telescopic chimeric medial gastrocnemius-medial sural artery perforator flap (G-MSAP) can be a good option for the reconstruction of mid- to distal lower leg injuries. Here we describe an in-series chimeric flap consisting of the isolated medial head of the gastrocnemius muscle i.e. based on the medial sural artery and its overlying skin paddle (MSAP) which is raised separately as independent component of the chimeric MSAP flap to cover the middle third of the leg with direct closure of the secondary defect.