title: Lower Extremity Reconstruction with Free Gracilis Flaps.
abstract: BackgroundThere have been significant advancements in lower extremity reconstruction over the last several decades, and the plastic surgeon's armamentarium has grown to include free muscle and fasciocutaneous flaps along with local perforator and propeller flaps. While we have found a use for a variety of techniques for lower extremity reconstruction, the free gracilis has been our workhorse flap due to the ease of harvest, reliability, and low donor site morbidity.MethodsThis is a retrospective review of a single surgeon's series of free gracilis flaps utilized for lower extremity reconstruction. Demographic information, comorbidities, outcomes, and secondary procedures were analyzed.ResultsWe identified 24 free gracilis flaps. The duration from injury to free flap coverage was ≤ 7 days in 6 patients, 8-30 days in 11 patients, 31-90 days in 4 patients, and > 90 days in 3 patients. There were 22 (92%) successful flaps and an overall limb salvage rate of 92%. There was one partial flap loss. Two flaps underwent incision and drainage in the operating room for infection. Two patients developed donor site hematomas. Four patients underwent secondary procedures for contouring. Our subset of pediatric patients had 100% flap survival and no secondary procedures at a mean 30-month follow-up.ConclusionThis study demonstrates the utility of the free gracilis flap in reconstruction of small- to medium-sized defects of the lower extremity. This flap has a high success rate and a low donor site morbidity. Atrophy of the denervated muscle over time allows for good shoe fit, often obviating the need for secondary contouring procedures.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Franco
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nicoson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Rajiv P
authors.initials: RP
authors.lastname: Parikh
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Tung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000706:statistics & numerical data; D000071976:Gracilis Muscle / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult