Objectives: To evaluate the surgical outcome of gastrocnemius flap for reconstruction after excision of recurrent or resistant upper leg ulcer and its impact on quality of life (QOL) of these patients
Patients & Methods: The study included 23 patients with chronic upper leg ulcer; 14 recurrent and 9 resistant ulcers. Through an anteromedial leg incision the appropriate head of gastrocnemius muscle was dissected and released from the Achilles tendon and passed through a skin tunnel to fill the defect of ulcer excision and was covered by split thierch skin graft. Collected data included duration of surgery, amount of blood loss, need for blood transfusion and frequency of complications and postoperative (PO) hospital stay. The impact of chronic leg ulcer on patients' QOL was evaluated using the Dermatology Life Quality Index (DLQI) preoperatively and 6-months PO.
Results: Fourteen patients had medial and 9 patients had lateral gastrocnemius flap. All patients had uneventful intraoperative course with a mean operative time of 94.5±14.2; range: 70-120 minutes; 6 patients required <90 minutes for completion of the procedure and 17 patients required >90 minutes for completion of the procedure. Mean intraoperative blood loss was 343.5±71.2; range: 200-450 ml; 11 patients had blood loss of <300 ml, while 12 patients had blood loss of >300 ml. Seventeen patients showed PO improvement of scoring of differential items of DLQI, while 6 patients showed stationary scoring. Mean PO total DLQI scoring was significantly lower compared to preoperative scoring. PO categorization of patients according to DLQI showed significantly higher frequency of patients among no (n=9) and mild (n=10) impact strata and only 4 patients had moderate impact, while no patient was still had severe impact of ulcer on their QOL compared to preoperative strata.
Conclusion: Gastrocnemius flap is a versatile coverage material for recurrent or resistant upper leg ulcer. It provides safe, effective and maintained coverage thus allowing healing and ended the dilemma of recurrence with significant improvement of QOL scoring of patient
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