J Reconstr Microsurg 2002; 18(5): 397-400
DOI: 10.1055/s-2002-33023
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Reinnervated Medial Gastrocnemius Free Flap for Closure of a Recurrent Ischial Pressure Sore: Case Report

Jonathan W. Jones
  • Private Practice, Reconstructive Plastic Surgery, Hand and Microsurgery, San Diego, CA.
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Juli 2002 (online)

ABSTRACT

A 42-year-old T7 level paraplegic man had undergone multiple local flap transfers for closure of a recurrent left ischial pressure sore. When wound breakdown again occurred and regional flap transfers were no longer a possibility, a medial gastrocnemius free flap was transferred to the ischial region. Reinnervation of this flap was accomplished by interposing a sural nerve graft between a proximal intercostal nerve and the tibial motor nerve branch of the gastrocnemius muscle. Following the return of protective sensation, the patient has developed no new ischial pressure ulcerations.

REFERENCES

  • 1 Landis E M. Micro-injection studies of capillary blood pressure in human skin.  Heart . 1930;  15 209-228
  • 2 Kosiak M. Etiology and pathology of ischemic ulcers.  Arch Phys Med Rehab . 1959;  40 62-69
  • 3 Mathes S J, Nahai F. Clinical Applications for Muscle and Myocutaneous Flaps.  St. Louis: C.V. Mosby 1982
  • 4 Penna M M, Drew G S, Smith S J, Given K S. The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores.  Plast Reconst Surg . 1992;  92 90-5
  • 5 Royer J, Pickrell K, Georgiade N. Total thigh flaps for extensive decubitus ulcers. A 16 year review of 41 total thigh flaps.  Plast Reconstr Surg . 1969;  44 109-118
  • 6 Dibbel D G. Use of a long island flap to bring sensation to the sacral area in young paraplegics.  Plast Reconstr Surg . 1974;  54 220-223
  • 7 Daniel R K, Terzis J K, Cunningham D M. Sensory skin flaps for coverage of pressure sores in paraplegic patients.  Plast Reconst Surg . 1976;  58 317-328
  • 8 Goldberg J A, Barwick W J, Levin L S. Restoration of sensation in paraplegia by a sensory innervated plantar fillet free flap: case report.  Paraplegia . 1995;  33 116-119
  • 9 Kuntscher M V, Blome-Eberwein S, Peltzer M, et. al.  The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg . 2001;  4 885-896
  • 10 Keller A, Allen R, Shaw W. The medial gastrocnemius muscle flap: a local free flap.  Plast Reconstr Surg . 1984;  73 302-307
  • 11 Potparic Z, Colen L B, Sucur D, Carwell G R. The gastrocnemius muscle as a free-flap donor site.  Plast Reconstr Surg . 1995;  95 1245-1252
  • 12 Hallock G G. Closure of an ischial pressure sore using a free gastrocnemius musculocutaneous flap with a long venous pedicle.  Br J Plast Surg . 1995;  48 504-506
  • 13 Chang K N, DeArmond S J, Buncke H J. Sensory reinnervation in microsurgical reconstruction of the heel.  Plast Reconstr Surg . 1986;  78 652-663