European Journal of Cardiovascular Medicine

Introduction: Soft tissue defects in the middle and upper leg, knee and lower thigh are often encountered by reconstructive surgeons. Although perforator flaps and vascularized free flaps have been reported to reconstruct these defects more frequently, gastrocnemius muscular and myocutaneous flaps remain good alternatives for repairing these defects due to their relatively easy and quick procedure, large dimension, and reliable survival. The medial gastrocnemius myocutaneous flap with a larger dimension and wider reach was applied more frequently to cover these defects, while the lateral gastrocnemius myocutaneous (LGM) flap was used to resurface the defects when the defects were predominantly located in the lateral aspect of the regions mentioned above or when the medial gastrocnemius myocutaneous flap was unsuitable because its integrity was destroyed. Materials and methods: This is a prospective and observational study was conducted in the Department of Anatomy at Department of Anatomy at Kannur Medical College, Anjarakandy over a period of 1 year consist of 20 sample. In prior anatomic dissections almost all limbs had at least 1 large musculocutaneous perforator to the overlying calf skin that exited via the medial head of the gastrocnemius muscle, so that a true muscle perforator flap could be raised from that territory. The majority of these perforators were clustered in the distal half of the muscle and emanated near the raphe separating the 2 heads of the gastrocnemius. The mean distance of these perforators from the origin of the medial sural artery at the popliteal artery was 15.3 cm. (range, 10–20.5 cm.), which represents the maximum pedicle length for this as a local flap. Result: In the area defined as the medial flap we found an average of 3.7 perforators arising from the medial sural artery and 2.9 arising from the posterior tibial artery. In the medial flap the distal most perforator was the posterior tibial septocutaneous perforator, which was at an average 25.5cm from the intercondylar line, around 7.9 cm farther away from the distal most medial sural perforator. In the lateral flap region we found an average of 2.9 lateral sural perforators along with 2.7 peroneal perforators. In this flap the distal most perforator was the peroneal septocutaneous, at an average distance of 24.2cm distal to the intercondylar line and at an average of 7.3cm further away from the distal most lateral sural perforator. Conclusion: On analysis of the data we found that it could be possible to raise combined flaps which include both the sural perforators emerging through the gastrocnemius muscle and the posterior tibial or the peroneal septocutaneous perforators.