The island pedicle rotation advancement gastrocnemius musculocutaneous flap for complete coverage of the popliteal fossa

The medial head of the gastrocnemius flap is a large, versatile flap that can be used to cover areas above the popliteal fossa, thereby minimizing the necessity for amputation in many trumatic injuries to this area. By advancing the medial head of the gastrocnemius muscle and rotating it on the neurovascular pedicle of the medial sural vessels, we have covered a 17 cm x 20 cm defect of crushed muscle, tendon, and bone in a leg that was traumatically amputated proximal to the knee. This procedure makes possible muscular coverage for bone, stainless steel plate, and reanastomosed arteries and veins above the knee and provides skincoverage extending to 70% of the circumference of the popliteal fossa. Autografting provides coverage for the remainder of the wound. Subsequent extension and flexion of the viable knee joint was achieved.