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Functional Donor-Site Morbidity During Level and Uphill Gait After a Gastrocnemius or Soleus Muscle-Flap Procedure
In�s A. Kramers-de Quervain, MD; Jörg M. Lüuffer, MD; Kurt Küch, MD, PD; Otmar Trentz, MD, Prof; Edgar Stüssi, PhD, Prof
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Investigation performed at the Laboratory for Biomechanics, ETH Zürich, Switzerland
In�s A. Kramers-de Quervain, MD Edgar Stüssi, PhD, Prof Laboratory for Biomechanics, ETH Zürich, Wagistrasse 4, CH-8952 Schlieren, Switzerland. E-mail address for I.A. Kramers-de Quervain: kramers@biomech.mat.ethz.ch
Jörg M. Lüuffer, MD Inselspital, CH-3010 Bern, Switzerland
Kurt Küch, MD, PD Kantonsspital Winterthur, CH-8400 Winterthur, Switzerland
Otmar Trentz, MD, Prof Universitütssiptal Zürich, Rümistrasse 100, CH-8091 Zürich ZH, Switzerland
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

J Bone Joint Surg Am, 2001 Feb 01;83(2):239-239
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Background: There 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.

Methods: Five 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.

Results: Gait 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.

Conclusions: We 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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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