Abstract
Background There 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.
Methods This 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.
Results We 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.
Conclusion This 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.
Keywords
lower extremity reconstruction - gracilis muscle flap - free gracilis
