The medial gastrocnemius muscle with an achilles tendon sheath extension flap as a versatile myo-tendon sheath flap for coverage of the upper two-thirds of the tibia and pre-tibial area: a preliminary report.

The idea of using the leg tendon sheath as a pedicled fascial flap was first described by the author in April 2003. To extend this new idea, the author studied the blood supply and gross features of the outer layer of the Achilles tendon sheath. The findings of that study supported the feasibility of using the medial gastrocnemius muscle with an Achilles tendon sheath extension flap to cover defects over the upper two-thirds of the tibia. Six flaps of the Achilles tendon sheath survived, and the split skin grafts over the tibia took; but, in one flap, the distal 1 cm was lost. The length of follow-up was 3 years for all cases. The results demonstrated safe elevation of up to 8 cm of distal extension.