The gastrocnemius muscle flap has gained wide acceptance as a reconstr
uctive technique for management of wounds of the knee and proximal tib
ia. The use of the muscle as a pedicle flap to the distal and middle f
emur has not been well quantified, and the proximal rotation are has b
een underestimated. We report the use of the island gastrocnemius pedi
cle flap to reach two femur defects 21 and 26 cm above the joint line;
achieved by taking advantage of the favorable location of the vascula
r pedicle above the joint line and the individual length of the medial
gastrocnemius muscle belly. Evaluation of standard arteriograms sugge
sts the location of the medial sural artery pedicle is an average of 3
2 +/- 14.5 (SD) mm above the inferior border of the femur. All vessel
origins were found above the joint line by radiograph. A common sural
artery origin was noted in 32% of patients at a mean distance of 35 mm
proximal to the joint line. Despite a wide range, 62% of sural artery
origins were within 1 cm of an axis drawn through the widest point of
the femoral condyles.