The gastrocnemius muscle has a Nahai-Mathes Class I pattern of circulation with two heads of origin. The muscle can be split into its medial and lateral heads, each with its single neurovascular pedicle.
The medial sural arterial branch has an external diameter of 2 to 2.5 mm with a length of 4 cm. The lateral sural arterial branch has an external diameter to 2 to 2.4 mm and 4cm pedicle length.
As the population ages, there are many individuals with knee replacements secondary to osteoarthritis as well as many individual who may have suffered trauma. Medical co-morbidites, such as diabetes, may predispose to osteomyelitis.
Rotation of the medial head of the gastrocnemius to cover exposed hardware, exposed bone or tendon, or tibial osteomyelitis is a useful flap commonly employed by Plastic & Reconstructive Surgeons. 
Harvest of the gastrocnemius muscle flap through either a posterior incision or medial fasciotomy incision can allow the surgeon to rotate the muscle anteriorly to cover the patella, knee joint and proximal one-third of the tibia.
Typically patients who require gastrocnemius muscle flaps are closely coordinated with various medical and surgical specialties that work as a team to optimize patient care. These teams include infectious disease specialists, orthopedic surgeons, plastic & reconstructive surgeons, internal medicine physicians, and physical therapists who work together to optimize patient care.
Once the infected or exposed area is thoroughly debrided and hardware cleaned as much as possible, the muscle is rotated into the defect. Antibiotics delivered to the area with the help of the muscle flap can facilitate healing or suppress infection while the body attempts to heal.http://www.drbriandickinson.com/
