Gastrocnemius-plasty for primary closure of compound injuries of the knee.

Free skin grafting has become recognised as a valuable part of the primary treatment of traumatic skin defects. However, free skin grafts can be used only when the base of the wound is vascularised. Fascia and muscle are ideal recipient sites whereas covering of tendons, bones and open joints needs pedicle flaps carrying their own blood supply. When extensive skin loss has occurred around an open joint, it is not possible to close the joint with local skin plastic procedures. It is therefore usually necessary in such cases to employ skin flaps from neighbouring regions-for instance, abdominal flaps for the upper limbs or cross-leg flaps for the lower limbs. Extensive lesions of this type are seen in the lower limbs when an individual is dragged along the road surface by a motor vehicle. In two such cases, we have used a local muscle flap to cover the gaping knee instead of a flap from the opposite leg.