Botulinum toxin A muscle chemodenervation allows for immediate weight-bearing after pedicled gastrocnemius flap reconstruction
Lilly F. Stadelmeier, Joris E. Eeuwen, Paneed Jalili, Laura Hilbig-Vlatten, Arriyan S. DowlatshahiBackground:
Soft tissue defects around the knee are a commonly encountered surgical scenario, with the gastrocnemius muscle flap having emerged as a reliable option due to its proximity, versatility, and consistent vascular supply. However, excessive tension during flap inset can lead to wound complications, delaying mobilization and limiting early postoperative rehabilitation. We introduce a technique for flap inset using intraoperative injection of botulinum toxin A (BTX-A).
Materials and Methods:
A retrospective case series of four female patients (mean age: 49 y, range: 36–58) undergoing gastrocnemius muscle flap reconstruction for knee soft tissue defects was performed. Intraoperatively, 100 units of BTX-A diluted in 10 mL of normal saline were injected into the gastrocnemius muscle belly before flap inset using a 30-gauge needle. Indications included anticipated tight inset, concern for patient compliance, or planned early mobilization. Early range of motion and weight-bearing were initiated between postoperative days 2 and 7. Institutional review board approval was obtained.
Results:
All four patients achieved complete wound healing without flap dehiscence or other complications. Early mobilization and weight-bearing were tolerated in all cases. No adverse events related to BTX-A administration were observed.
Conclusion:
Intraoperative BTX-A injection into the gastrocnemius muscle flap may facilitate tension-free inset and enable early postoperative mobilization without compromising wound healing. This technique could represent a useful adjunct in high-risk reconstructions where delayed mobilization is undesirable.