Although with the reported versatility, vascular
reliability, and easy harvesting and elevation of the gastrocnemius
muscle flap, still it is used for a narrow aspect of
reconstructions including only small and nearby defects.
The flap is unfortunately full of limited applications, unreachable
coverage, and soft tissue shortage. In this work,
we are presenting 20 cases of gastrocnemius muscle flap of
different etiologies, in which we applied a group of modifications
to have a higher grade of applicability, more arc of
rotation, and more tissue surface area. The validity of these
modifications was intraoperatively tested in different defect
sites and sizes to report if they are really meaningful. All flaps
had survived with no complications. We have summarized
these modifications in four golden rules, making these muscle
flaps more versatile and more applicable. An algorithm is
suggested as a leading tool for the best choice of the gastrocnemius
muscle units in different situations.