limb salvage procedures, Gastrocnemius muscle flaps, skeletal reconstruction, reconstructive surgical procedures, tibial bone coverage.INTRODUCTION Lower extremity trauma due to a car crash or war mine explosion is still challenging. The early history of the lower extremity reconstruction dates back to the Hippocrates (460-370BC). Since then, until the First World War, amputation was the best option for saving the lives of the patients.Sushruta Sumhita (600BC) was the first person who used the cheek flap for nasal reconstruction.However, the new era of the flap reconstruction commenced during the First World War.Although in that time Stark was the first person who used muscle flap to cover lower extremity due to osteomyelitis, the first report of the lower extremity reconstruction by muscle flap was done by Ger.Gastrocnemius muscle has also been used to cover the exposed implant of tibia and knee prosthesis.Early coverage of the complicated wound of the tibia by the Gastrocnemius muscle flap can prevent major complications.

Ischemia-reperfusion (IR) injury to the lower extremities causes damage to various tissues, notably the limbs. Because research in recent years have demonstrated that saffron and its components are useful in ischemic strokes, the goal of this study was to see whether Crocin (Cr), one of the active constituents in saffron, could protect the Gastrocnemius muscle from IR injury. A total number of 32 Sprague-Dawley rats were randomized into four groups randomly: control, Cr, IR, and IR + Cr. Xylazine and ketamine were used to anesthetize all of the rats. The left lower limbs of the other two groups were subjected to 2 hr of ischemia and 2 hr of reperfusion with tourniquet, with the exception of the control and Cr groups. Tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), IL-1β, total antioxidant status (TAS) and total oxidant status (TOS) levels were assessed in the blood as well as muscle IL-6, IL1β, SOD1-2, catalase (CAT) and glutathione peroxidase (GPx) expression. According to the IR group, increases in TAS levels and decreases in TNF-α, IL-6, and IL-1β levels were substantial in the Cr therapy group. Cr significantly reduced IL-6 and IL-1β mRNA expression levels in the muscle of the IR group and increased superoxide dismutases 1 (SOD1), SOD2, catalase (CAT), and GPx. Our data showed that Cr protected the Gastrocnemius muscle from IR injury in rats and reduced inflammatory markers significantly. These effects of Cr might have been mediated by improved antioxidant enzyme activity, suppression of free radical generation and reduction of oxidative stress.

Purpose: In this study we compared soleus and Gastrocnemius responses to the paired stimulation in order to reveal embedded information in the H- reflex of these muscles.Materials and Method: Four men with ages between 20 and 26 were tested. Because there was no ideal point based on the scientific rules to record the h-reflex from the Gastrocnemius, we were to determine an ideal point and electrode placement from anatomical and physiological point of view. After this step, the soleus and Gastrocnemius were subjected to the paired stimulus and we record the h-reflex recovery curve of these muscles. To record the recovery curve, 11 pairs of stimulus were delivered to the posterior tibial nerve. The time interval between the 1st pair of the stimulus was 50 ms and was increased by 20 ms steps in the next pairs up to 250 ms. Relation of the second h-reflex amplitude to the first was calculated and expressed in percent. Then we draw the recovery curve using these values.Result and discussion: While the time interval of the paired stimulus was less than 110 ms, the behavior of the curves were similar. In this stage we guess that the muscles are impressed by the renshaw cells inhibition and the fatigue is induced by the first stimulus. When the interval of a pair was 110 ms or more the recovery of soleus was significantly higher than the Gastrocnemius. This behavior may be due to a lesser fatigability of the soleus motoneurons and a less renshaw inhibition on the slow motoneurons of the soleus. When the time interval of a pair stimulus was increase1 to more than 170ms, both of the curves behave alike. The cause may be the diminishing of the renshaw cell inhibition and the reduction of the fatigue.Conclusion: Because of the physiological properties of motoneurons, when we excite the h-reflex, smaller motoneurons recruite predominantly; but comparing the soleus (slow) and Gastrocnemius (fast) recovery curve behavior shows that the information of the fast motoneuron is included in the h-reflex. Using this procedure, we can assess different motoneuron and renshaw cell activities, indirectly. Of course this needs more controlled studies.

Background and purpose: Balance impairment is one of the major health problems in elderly. Kinsiotaping and stretching techniques are effective in balance improvement. To the best of our knowledge, no study have compared the effects of kinesiotaping and stretching of Gastrocnemius on balance in elderly. So, we aimed at comparing the effects of these two methods on balance in elderly.Materials and methods: In this randomized clinical trial, 40 elderly women and men were randomly assigned into 2 groups of kinesiotaping and stretching. Inhibitory tape was applied on the Gastrocnemius while in stretching group, the muscle was stretched for 60 seconds in 4 times. The static balance was examined before and after the interventions, using single leg stance test and checking the changes of center of pressure by force plate. According to normal distribution of data, Independent t-test was used to compare the means between groups and paired t-test was used for within group analysis.Results: Despite progress in time of unilateral standing after the interventions, the changes were not significant (P>0.05). Mediolateral changes of center of pressure in females were significantly lower after the use of stretching rather than kinesiotaping (P=0.04). Moreover, elderly women showed significant decrease in mediolateral changes of center of pressure after the use of stretching compared with that before the use (P=0.02).Conclusion: The short term effect of Gastrocnemius stretching could lead to significant improvement of mediolateral balance in elderly female. Also, the decreasing trend in changes of center of body mass in men after the stretching may indicate the effectiveness of this treatment.

Introduction: Plantarflexor muscles produce propulsive force in the second half of stance phase; deficient motor output from these muscles would lead to inadequate propulsion at push off phase of gait following stroke. It is important to develop strategies to improve plantarflexor output. This study examined the effects of walking on a treadmill at varying gradients and speeds on medial Gastrocnemius (MG) muscle activation in stroke survivors.Materials and Methods: Nineteen stroke survivors (13M/6F: average age 55.37±7.54 years; body mass index 29.10±4.52kg/m2) participated in the study. Participants walked on a standard treadmill at three different positive inclines (0o, 3o, and 6o) and speeds (self-selected, self-selected+20%, self-selected+40%). The electromyographic activity of MG recorded at push off phase of the gait.Results: A linear mixed model regression analysis was used to analysis. The paretic MG muscle activity increased at faster speeds irrespective of incline (p<0.05). In contrast, the MG muscle activity increased at higher incline in the non-paretic side (P<0.05), but not in the paretic side (P>0.05).Conclusion: It would appear that stroke survivors employ distinct muscle activation strategies on the paretic and non-paretic sides in response to different walking speeds and inclines.