The inferiorly based gastrocnemius muscle flap: Anatomic aspects

The arterial communication between the gastrocnemius muscle heads through t heir lowest anastomotic arteriole bundle alone was examined in specimens fr om 14 fresh cadavers. In 3 specimens, the larger vessels in close vicinity to the lowest vessels were preserved as well. Distinct communication betwee n the arterial networks of the heads was demonstrated in all cases after in jecting dyes through both sural arteries or into die lateral sural artery a nd the lowest anastomotic arteriole in 11 and 3 specimens, respectively. Th erefore, it seems that one head can be adequately supplied from the contral ateral one through their lowest anastomotic arteriole(s); nevertheless, the location of this vessel varies significantly and cannot be detected preope ratively. Measurements demonstrated that although this vessel is not found at a constant level, it is invariably detected in the lower third of the me dial gastrocnemius head's length and, in 93 percent of cases, in the lower fourth. Thus, rough preoperative planning becomes feasible. Given that the venous communication between the heads has been documented a s well, the authors think that an inferiorly based flap of the medial gastr ocnemius head for defects of the middle third of the tibia might be both re liable and applicable; however, for reasons of safety, the muscle heads sho uld remain attached along their lower third.