Gastrocnemius Flap for Proximal Tibia and Knee Wound Coverage

Description

In this instructional video, Dr. Janet Conway at the Rubin Institute provides a comprehensive guide on performing flap coverage for lower extremity wounds, specifically focusing on the use of the gastroc flap for anterior knee defects following total knee infections. The presentation begins with the identification of the wound and an emphasis on assessing blood flow through preoperative examinations. Dr. Conway meticulously details the surgical process, starting with the incision along the posterior border of the calf in line with the gastrocnemius muscle, ensuring minimal elevation of the fascia from the skin.



She stresses the importance of preserving the underlying fascia and gently dissecting the muscle to isolate the gastrocnemius while avoiding damage to critical nerves and blood vessels, notably the saphenous nerve and the sural artery. Upon successful dissection, she measures the muscle to ensure it adequately covers the defect, extending the incision as necessary to acquire sufficient length while maintaining the vascular integrity of the muscle.



Dr. Conway showcases various techniques for dissection and muscle elevation, including the use of blunt and sharp dissection tools, while demonstrating the anatomical landmarks involved. She explains the process of tunneling the flap beneath the skin to prevent strangulation of the tissue and details the necessary postoperative care, including the use of a skin graft and immobilization techniques to support healing.



Throughout the procedure, Dr. Conway emphasizes key precautions to prevent complications and maximize the chances of successful healing, such as proper positioning of the patient and monitoring for swelling. The detailed nature of the tutorial provides invaluable insights for medical practitioners interested in advanced surgical techniques for wound coverage.

DOI: 10.1302/3114-230045

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