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Simultaneous calf reduction and contouring with customized differential subtotal gastrocnemius resection and muscle transposition: Analysis of 200 cases

  • Honda Hsu
    Affiliations
    Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Ming Seng Road, Dalin, 622, Taiwan

    School of Medicine, Tzu Chi University, 701 Zhongyang Rd, Sec. 3, Hualien 97004, Taiwan
    Search for articles by this author
  • Jiunn-Tat Lee
    Correspondence
    Corresponding author at: Division of Plastic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan and School of Medicine, Tzu Chi University, 701 Chung-Yang Road, Sec. 3, Hualien 970, Taiwan.
    Affiliations
    School of Medicine, Tzu Chi University, 701 Zhongyang Rd, Sec. 3, Hualien 97004, Taiwan

    Division of Plastic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707 Zhongyan Rd, Sec 3, Hualien 97004, Taiwan
    Search for articles by this author
Published:August 26, 2022DOI:https://doi.org/10.1016/j.bjps.2022.08.073

      Summary

      Background

      Oversized muscular calves can cause severe emotional distress. Total, partial, and subtotal resections of the gastrocnemius muscle for calf reduction have been described. However, the amount of muscle resected may be inappropriate, and the resultant leg contour may not be straight or esthetically pleasing enough.

      Objectives

      This study aimed to describe a technique of customized differential subtotal gastrocnemius resection and muscle transposition.

      Methods

      A total of 200 patients who underwent customized differential subtotal gastrocnemius resection and muscle transposition for hypertrophic muscular calves from July 2013 to June 2016 were included in the study.

      Results

      A total of 148 patients underwent subtotal resection of both heads, and calf reduction ranged from 3.2 to 7.2 cm (mean 14.8%). Forty-two patients underwent subtotal resection of the medial head alone, and calf reduction ranged from 2.8 to 5.5 cm (mean 9.2%). Ten patients underwent subtotal resection of the lateral head alone, and calf reduction ranged from 1.2 to 2.1 cm (mean 4.6%). The medial gastrocnemius muscle was subtotally resected in 190 (95%) patients. In 130 (65%) patients, the preserved medial gastrocnemius muscle was transposed superomedially to achieve a straighter medial contour. None of the patients complained that their legs were too thin because of over-reduction. Cybex test showed that near-total muscle strength recovery was achieved within 6 months.

      Conclusion

      Customized differential subtotal gastrocnemius resection together with muscle transposition resulted in enhanced calf reduction with straighter leg contour, without any impairment of the leg function. This approach may be more appealing to both patients and surgeons.

      Keywords

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