Relative Donor Site Morbidity and Complication Rates of Gracilis Myocutaneous and Muscle Flaps in Reconstructive Surgery

Abstract

Background

The gracilis flap is a versatile muscle flap that can be utilized as a muscle-only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have compared donor site complications of free and pedicled gracilis flaps, including the effect of skin paddle harvest on donor site morbidity.

Methods

We performed a retrospective review of patients who underwent a free or pedicled gracilis flap at our institution from 2013 to 2023. Gracilis flaps were categorized as: pedicled gracilis muscle flaps, free gracilis muscle flaps, and free gracilis myocutaneous flaps. Outcome variables were duration of drain placement and complications, including seroma, hematoma, infection, dehiscence, and persistent numbness.

Results

We identified 128 gracilis flaps, including 19 free myocutaneous flaps, 35 free muscle flaps, and 74 pedicled muscle flaps. Free myocutaneous flaps required longer drain placement as compared to free muscle flaps or pedicled flaps (13.6 days vs. 8.4 days vs. 7.4 days, respectively, p = 0.002). Free myocutaneous flaps displayed a higher complication rate (36.8%) as compared to pedicled muscle flaps (10.8%) or free muscle flaps (11.4%, p = 0.020). After adjusting for age, BMI, and ASA status, free myocutaneous flaps demonstrated higher odds of major donor site complications as compared to pedicled muscle flaps (OR: 1.23, p < 0.001), while free muscle flaps were not associated with increased odds of major complications (OR: 1.08, p = 0.117). Of the documented complications, the most common were surgical site infection (36.8%), hematoma (21.1%), and seroma (21.1%).

Conclusion

The inclusion of a skin paddle during gracilis flap harvest is associated with increased duration of drain placement and donor site complications, including surgical site infection, hematoma, and seroma. These factors should be carefully considered in the context of patients' reconstructive needs and other risk factors.

Keywords

gracilis - donor site - morbidity - muscle flap - myocutaneous flap

Publikationsverlauf

Eingereicht: 06. November 2024

Angenommen: 20. September 2025

Accepted Manuscript online:
10. Oktober 2025

Artikel online veröffentlicht:
30. Oktober 2025

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