Functional Donor-Site Morbidity During Level and Uphill Gait After a Gastrocnemius or Soleus Muscle-Flap Procedure

• Published in: Journal of bone and joint surgery. American volume Vol. 83; no. 2; p. 239
• Main Authors: Kramers-de Quervain, Inés A., Lüuffer, Jörg M., Küch, Kurt, Trentz, Otmar, Stüssi, Edgar
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.02.2001; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Adolescent; Adult; Biological and medical sciences; Biomechanical Phenomena; Electromyography; Female; Gait; Humans; Isometric Contraction; Leg Injuries - surgery; Male; Medical sciences; Middle Aged; Movement; Muscle Weakness - etiology; Muscle, Skeletal - physiopathology; Muscle, Skeletal - transplantation; Orthopedic surgery; Postoperative Complications; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps - adverse effects; Tissue and Organ Harvesting - adverse effects; Human; Postoperative; Evaluation; Donor site; Diseases of the osteoarticular system; Lower limb; Plastic surgery; Osteosynthesis; Soleus muscle; Striated muscle; Trauma; Morbidity; Walking; Orthopedic surgery; Treatment; Open fracture; Tibia; Complication; Gastrocnemius muscle; Bone; Technique; Flap (surgery); Quantitative analysis
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200102000-00012

BackgroundThere is only limited objective information about functional donor-site morbidity after harvest of one head of the triceps surae muscles to cover a severe soft-tissue defect of the leg. The purpose of the present study was to investigate whether a functional deficit is present during level and uphill walking after such a procedure.MethodsFive subjects who had completely recovered from the initial injury were studied with use of comprehensive gait analysis during free level, fast level, and uphill walking on a ramp at a 10° inclination.ResultsGait analysis revealed no relevant donor-site morbidity affecting level gait at a free walking speed (mean, 1.27 m/sec; range, 1.18 to 1.40 m/sec). When the subjects walked at a higher velocity (mean, 1.89 m/sec; range, 1.58 to 2.43 m/sec), an asymmetry of the ground-reaction forces was seen. The second vertical peak force during push-off was reduced by a mean of 7.3% (range, 0.94% to 12.24%), and the impulse in the direction of progression was reduced by a mean of 8.7% (range, 0.13% to 17.87%) on the affected side (p = 0.04). During uphill walking, a compensatory strategy to reduce the demand on the posterior calf muscles was seen in all subjects-that is, they shortened the length of the step on the contralateral side by a mean of 3.9 cm (range, 2.2 to 6.2 cm), which corresponded to a mean side-to-side difference of 5.6% (range, 2.18% to 6.18%) (p = 0.04). A calcaneal motion pattern, denoted as increased ankle dorsiflexion, was seen in three of the five subjects during uphill walking as a sign of decreased function of the posterior calf muscles. Two of them (both with a soleus flap) also had a calcaneal pattern during fast gait.ConclusionsWe concluded from this study that the functional donor-site morbidity after harvest of one head of the triceps surae muscles is mild in subjects who have had a complete recovery from their initial injury. Normal level gait is possible. However, deficits are seen in more demanding tasks such as fast walking or uphill walking.