Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type III open fracture.

The traditional pedicled gastrocnemius muscle flap has often been used to repair soft-tissue defects caused by trauma. However, it is difficult to cover skin defects in the distal third of the lower extremity because of its range of excursion. We have attempted use of a free ipsilateral gastrocnemius muscle flap for coverage of skin defects in the distal third of the lower extremity. In three patients with skin defects due to Gustilo type III open fractures, a free gastrocnemius flap was used for coverage of the same leg. The follow-up period ranged from 12 months to 2 years. Microsurgical anastomosis of the vascular pedicle to the tibialis posterior vessels was performed by end-to-side anastomosis proximally to the ankle. The postoperative course was uneventful and showed stable coverage of the wound. All free flaps were successfully transferred, and the defects healed primarily. Bone fusion in all of the patients in this series progressed satisfactorily. This free muscle flap is useful for reconstruction of defects in the distal third of the lower extremity in Gustilo III open fractures.