Gastrocnemius flaps in the surgical treatment of sarcomas of the knee.

The authors discuss their experience with the pediculated gastrocnemius flap used in the oncological surgery of the knee, in 27 patients. Three groups of patients are evaluated: in one group the method was used in patients affected with bone sarcoma and associated with reconstruction of the resected bone segment; in another group the method was used after infection had occurred as a result of reconstructive surgery; in the third group the method was used at the same time as excision of sarcomas of the soft tissues. The gastrocnemius flap may be used to cover sufficiently wide areas of loss of skin and muscular substance around the knee, and may be effectively used to cover metallic prostheses or composite reconstructive implants (bone-cement-metal). We recommend using the covering technique at the same time as resection and reconstruction are performed in order to avoid the risk of infection, and thus reduce any changes in chemotherapy protocols that postoperative infection would require in these patients. The use of the gastrocnemius flap associated with excision of sarcomas of the soft tissues must be reserved for selected cases. The high incidence of local recurrence after such excisions indicates that either wider excisions using distant free flaps or the association of radiotherapy should be considered.