Utilizing a Pie-crusted Gastrocnemius Muscle Flap for Salvage in Severe Lower Leg Open Fractures with Partial Necrosis of Free Flaps: Two Case Reports

Abstract

  During soft tissue reconstruction for open fractures using free flaps, surgical manipulation during vessel anastomosis can lead to increased scarring around the blood vessels, thereby expanding the zone of injury. Consequently, the occurrence of partial necrosis in the free flap after surgery often necessitates more complex treatment, involving the anastomosis of additional free flaps farther away. We report two cases of open fractures in the lower leg with soft tissue defects in the middle third of the leg, resulting from partial necrosis following free flap reconstruction. We used an extended pedicled gastrocnemius flap obtained by fasciotomy. In both scenarios, the defect location rendered conventional gastrocnemius flaps impractical; however, by performing pie-crusting on the deep fascia of the gastrocnemius muscle and extending the flap, successful coverage was achieved. We consider the extended pedicled gastrocnemius flap obtained by fasciotomy to be a valuable alternative for the reconstruction of soft tissue defects beyond the conventional indications such as those found in the proximal third of the lower leg.