THE ISLAND POSTERIOR CALF FASCIOCUTANEOUS FLAP - AN ALTERNATIVE TO THE GASTROCNEMIUS-MUSCLE FOR COVER OF KNEE AND TIBIAL DEFECTS

The gastrocnemius muscle remains the workhorse for providing soft tiss ue over the knee and upper tibia. Nevertheless, we have found the isla nd posterior calf fasciocutaneous flap to be a valuable alternative. W e describe 10 cases in which an island posterior calf fasciocutaneous flap was used to cover defects over the knee and tibia. Three cases we re after knee arthroplasty wound dehiscence, three cases were of traum atic soft-tissue loss, three cases involved replacement of unstable sk in, and one case required closing a synovial fistula. This series is c ompared with 10 contemporaneous consecutive cases of soft-tissue loss around the knee that were reconstructed with a gastrocnemius muscle fl ap. Nine posterior calf fasciocutaneous flaps survived completely, and one flap had to be replaced because of poor flow. Although this flap is technically more demanding, we have found that it offers some advan tages over the gastrocnemius. These include a greater flexibility of s ize and shape, a longer are of rotation to reach suprapatellar defects , the provision of sensate skin with protective though crude sensation , less bulk, and the avoidance of a twitch. The flap is also easy to r e-elevate from the recipient site for subsequent orthopedic work.