Abstract
Purpose: To describe the technique and outcomes of patients requiring Lateral Gastrocnemius flaps for soft tissue coverage of the lateral side of the knee after sarcoma.
Methods: Four patients with sarcomas on the lateral knee capsule were identified. 1 patient had an Osteosarcoma of the proximal tibia resected, requiring reconstruction. 2 patients had Malignant fibrous hystiocytoma proximal to the lateral knee joint and 1 patient had a leiomyosar-coma who presented after 6 failed local resections. The length of follow up is from 13 months to 5 years, average 3.25 years. There were no graft failures. The average surface area of the resection was 118 cm2. There were two sarcoma recurrences requiring excision and radiation. There was one death due to metastases. The technique involves the releasing the gastroc flap down to the aponeurosis and then the careful dissection of the peroneal nerve with delivery of the muscle up behind the peroneal nerve to the lateral aspect of the knee. The flap is rotated fibrous layer down and the muscle readily accepts a meshed skin graft taken locally, giving this technique the advantage of reconstructing a capsule and creating a superior bed for accepting skin grafts.
Results: Average time to healing was 3.8 weeks. There have been no nerve injuries, no graft loss and all had a function range of motion. The functional results have been very reliable. Using the musculoskeletal tumour society score (MSTS) and the Toronto Extremity Salvage Scoring (TESS) system we had an average MSTS score of 21.5 with a percent of 71.5 and a TESS score of 44.5 for the living patients. These correlate to very good outcomes.
Conclusions: The lateral gastrocs flap has a reputation of being technically complex. Meller et al.(1997) report peroneal nerve injuries in 8 of 27 cases. This institution has no complications with this flap and recommends it for soft tissue defects that extend to the midline on the lateral aspect of the knee joint.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
