• Sean Weiren Ong, Lee Ping Gan, and Dawn Sinn Yii Chia.
• Deaprtment of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore.
• J Orthop. 2020 Jan 1; 17: 13-16.

IntroductionLarger soft tissue defects over critical areas of the lower limb involving the knee and proximal two thirds of the tibia present a challenge to the reconstructive surgeon. Options include a large free flap or pedicled local flaps. The gastrocnemius or soleus flap alone is not sufficient. Combined gastrocnemius-soleus flaps can be used adequately without the need to resort to free flaps. We review the use and outcomes of the combined pedicled gastrocnemius and hemi-soleus double muscle flap to cover large defects of the leg and discuss our technique.Material And MethodsA retrospective review of the patients who underwent the pedicled double muscle (gastrocnemius and soleus) flap for wound resurfacing in our institution between 2008 and 2013 was performed. The patients' case notes were analyzed and data collected included their age, comorbidities, wound characteristics, surgical procedures and post-operative outcomes and complications.ResultsThere was a total of ten double flaps in ten patients; eight due to trauma and two due to infection. Mean follow up period was 12 months. All flaps achieved primary healing without major complications. There were two cases of minor complications: flap tip necrosis and superficial infection. Nine patients were able to achieve ambulation without aid at final follow up.ConclusionThe combined pedicled gastrocnemius and hemisoleus double muscle flap is a useful alternative for reconstruction of large critical soft tissue defects around the knee and leg.© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.

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