Scarification lengthening technique for the proximal pedicle medial gastrocnemius flap in the management of open leg fractures

Abstract

Open leg fractures frequently result in loss of substance, which can compromise the functional outcome of the lower limb. The resulting bone exposure presents a number of problems, including the need for coverage, which necessitates the utilisation of flap techniques. The medial gastrocnemius muscle flap with a proximal pedicle has an arc of rotation that restricts its use to covering the knee and the proximal epiphysis of the tibia. In this work, the authors propose a step-by-step technique for lengthening the medial gastrocnemius flap by scarification. This increases the flap's arc of rotation, compensating for the loss of bone substance and exposure of the tibia beyond its proximal epiphysis.