OBJECTIVETo study the anatomic basis of the bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing the composite Achilles tendon defect.

METHODSThe pedicle anatomy of the bi-pedicled V-Y gastrocnemius myocutaneous flap was examined on 30 cadaver specimens. The sliding distances of the flap were measured at different knee flexion degrees. The bi-pedicled V-Y gastrocnemius myocutaneous flap was applied in 12 cases of Achilles tendon defect with simultaneous skin and soft tissue defect.

RESULTSThe sural arteries could be classified into four types. After cutting off the gastrocnemius origin with a "Z-shaped" incision, the sliding distance of the flap reached (3.7+/-0.5) cm when the knee flexed 0 degree, (4.9+/-0.7)cm when the knee flexed 30 degree,(6.7+/-0.7) cm when the knee flexed 60 degree and (9.2+/-0.9) cm when the knee flexed 90 degree. All the defects healed. The patients recovered ambulation with satisfactory knee and ankle function. The follow-up was 4 months-12 years.

CONCLUSIONSDifferent sural artery types should be noticed during the harvest of the bi-pedicled-V-Y gastrocnemius myocutaneous flap. With 90 degree knee flexion, this flap is suitable for one-stage repair of composite Achilles tendon defect within 9.2 cm+/-0.9 cm.

Achilles Tendon ; injuries ; surgery ; Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps ; blood supply ; Tendon Injuries ; surgery