Medial gastrocnemius flap: infection control in megaprostheses
DOI:
https://doi.org/10.2340/jphs.v60.43537Keywords:
Gastrocnemius flap, megaprosthesis, infection, proksimal tibiaAbstract
Introduction: Medial gastrocnemius flaps are commonly employed in conjunction with endoprosthesis implantations for the management of malignant tumors affecting the proximal segment of the tibia. This study aimed to evaluate the effect of the routine transfer of the muscle on the incidence of infections within the surgical field.
Methods: Forty-three patients presenting with a suspected malignant tumor in the proximal segment of the cruris underwent evaluation at our hospital. The enrolled patients were stratified into two cohorts. Patients in Group 1 (n = 16) underwent a combined procedure involving a medial gastrocnemius flap and a megaprosthesis, whereas patients in Group 2 (n = 17) did not undergo flap surgery.
Results: In Group 1, osteosarcoma (OS) was diagnosed in seven patients (43%). Subsequently, oncologic resection with a wide margin was performed on the affected bone region, resulting in an average defect length of mean 12.81 ± 5.05 cm. The patients in this group were followed-up for an average duration of 34.06 ± 13.21 months. Similarly, in Group 2, OS was present in seven patients (41.17%), and they underwent identical oncologic resection procedures. The mean defect length in Group 2 was measured at mean 14.12 ± 4.54 cm. The average follow-up period for patients in Group 2 was 30.41 ± 12.06 months.
Conclusion: Within Group 1, four patients (25%) experienced infections within the surgical site, while within Group 2, five patients (29.4%) exhibited such infections (p > 0.05). The utilization of megaprostheses in osseous defect repair, either alone or in combination with gastrocnemius flaps, did not yield statistically significant differences in infection rates.
Downloads
References
Gosheger G, Gebert C, Ahrens H, et al. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. 2006; 450: 164–171. https://doi.org/10.1097/01.blo.0000223978.36831.39 DOI: https://doi.org/10.1097/01.blo.0000223978.36831.39
Grimer RJ, Belthur M, Chandrasekar C, et al. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res. 2002; 395: 193–203. https://doi.org/10.1097/00003086-200202000-00022 DOI: https://doi.org/10.1097/00003086-200202000-00022
Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg. 2006; 126(5): 289–296. https://doi.org/10.1007/s00402-005-0009-1 DOI: https://doi.org/10.1007/s00402-005-0009-1
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, et al. Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res. 2004; 420: 239–250. https://doi.org/10.1097/00003086-200403000-00034 DOI: https://doi.org/10.1097/00003086-200403000-00034
Bus MP, van de Sande MA, Fiocco M, et al. What are the long-term results of MUTARS® modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal Tibia? Clin Orthop Relat Res 2017; 475(3): 708–718. https://doi.org/10.1007/s11999-015-4644-8 DOI: https://doi.org/10.1007/s11999-015-4644-8
Donati D, Colangeli M, Colangeli S, et al. Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res. 2008; 466(2): 459–465. https://doi.org/10.1007/s11999-007-0055-9 DOI: https://doi.org/10.1007/s11999-007-0055-9
Gottsauner-Wolf F, Kotz R, Knahr K, et al. Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. A follow-up study of seventy patients. J Bone Joint Surg Am. 1991; 73(9): 1365–1375. https://doi.org/10.2106/00004623-199173090-00012 DOI: https://doi.org/10.2106/00004623-199173090-00012
Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011; 93(5): 418–429. https://doi.org/10.2106/JBJS.J.00834 DOI: https://doi.org/10.2106/JBJS.J.00834
Henderson ER, O’Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Joint J. 2014; 96-B(11): 1436–1440. https://doi.org/10.1302/0301-620X.96B11.34747 DOI: https://doi.org/10.1302/0301-620X.96B11.34747
Grimer RJ, Carter SR, Tillman RM, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 1999; 81(3): 488–494. https://doi.org/10.1302/0301-620X.81B3.0810488 DOI: https://doi.org/10.1302/0301-620X.81B3.0810488
Mavrogenis AF, Pala E, Angelini A, et al. Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol. 2013; 107(4): 335–342. https://doi.org/10.1002/jso.23216 DOI: https://doi.org/10.1002/jso.23216
Bibbo C. The gastrocnemius flap for lower extremity reconstruction. Clin Podiatr Med Surg. 2020; 37(4): 609–619. https://doi.org/10.1016/j.cpm.2020.07.002 DOI: https://doi.org/10.1016/j.cpm.2020.07.002
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3): 837–845. https://doi.org/10.2307/2531595 DOI: https://doi.org/10.2307/2531595
Sapino G, Osinga R, Maruccia M, et al. Role of the gastrocnemius musculocutaneous with a propeller style skin flap in knee region reconstruction: Indications and pitfalls. Arch Plast Surg 2023; 50(6): 593–600. https://doi.org/10.1055/s-0043-1768644 DOI: https://doi.org/10.1055/s-0043-1768644
Wittig JC, Villalobos CE, Hayden BL, et al. Osteosarcoma of the proximal tibia: limb-sparing resection and reconstruction with a modular segmental proximal tibia tumor prosthesis. Ann Surg Oncol. 2010; 17(11): 3021. https://doi.org/10.1245/s10434-010-1180-3 DOI: https://doi.org/10.1245/s10434-010-1180-3
Chim H, Tan BK, Tan MH, et al. Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Ann Plast Surg. 2007; 59(4): 398–403. https://doi.org/10.1097/01.sap.0000258955.27987.17 DOI: https://doi.org/10.1097/01.sap.0000258955.27987.17
Zhang Y, Yang Z, Li X, et al. Custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved. Surg Oncol. 2008; 17(2): 87–95. https://doi.org/10.1016/j.suronc.2007.11.003 DOI: https://doi.org/10.1016/j.suronc.2007.11.003
Sapino G, Guiller D, Osinga R, et al. Muscle-only versus chimeric musculocutaneous gastrocnemius pedicled flap in complex orthoplastic reconstructions of the knee region: a retrospective study. J Plast Reconstr Aesthet Surg. 2023; 77: 298–308. https://doi.org/10.1016/j.bjps.2022.12.006 DOI: https://doi.org/10.1016/j.bjps.2022.12.006
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Rana Kapukaya, Gazi Kutalmış Yaprak, Asena Ayça Özdemir, Ahmet Kapukaya
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from 2024 all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
