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J Reconstr Microsurg
DOI: 10.1055/a-2632-2663
Original Article

How Invasive is the Free Gracilis Muscle Flap? A Prospective Study on Donor Site Morbidity

Nikolaus Wachtel
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Riccardo E. Giunta
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Maximilian Hirschmann
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Marc Hellweg
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Tim Nuernberger
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Nicholas Moellhoff
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
,
Denis Ehrl
1   Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
2   Department of Plastic, Reconstructive and Hand Surgery, Burn Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nuremberg Hospital, Nuremberg, Germany
› Author Affiliations
Funding None.
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Abstract

Background

Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of free GM flaps.

Methods

A control group (n = 100) without surgery was recruited to assess interindividual differences in strength and range of motion (ROM) in the hip and knee joint (dominant vs. nondominant side). Additionally, for 50 patients with free GM flap surgery, these parameters were assessed in an identical manner.

Results

The control group showed significant interindividual differences in strength for abduction and adduction in the hip joint when comparing the dominant to the nondominant side, but no significant differences in the ROM. GM flap harvest led to no significant differences in maximum force 20.3 (± 13.8) months after surgery in all parameters/movements that were assessed. However, the ROM for abduction in the ipsilateral hip joint was significantly reduced after surgery.

Conclusion

The GM flap has a low donor site morbidity and should therefore be considered as a first-line option for microsurgical reconstructive procedures. Moreover, the low morbidity is not affected by preexisting differences in strength when comparing the dominant to the nondominant side.

Keywords

gracilis muscle flap - donor site morbidity - free flap morbidity - strength and ROM after gracilis muscle flap

Note

This study was presented at the 53 Annual Congress of the German Society of Plastic Surgeons (DGPRAEC)/27 Annual Congress of the Society for German Aesthetic Surgery (VDAEPC) (September 14, 2023).


Authors' Contributions

Conceptualization (D.E., R.E.G., N.M., N.W.); data curation (M.Hi., M.He., N.W., T.N.); formal analysis (D.E., N.W., M.Hi., T.N.); funding acquisition (n/a), investigation (D.E., N.W., M.Hi.); methodology (M.Hi., N.M., M.He.); project administration (D.E., R.E.G., N.M., N.W.); resources. (D.E., R.E.G., N.W.); software (M.Hi., M.He.); supervision (D.E., R.E.G., N.W., T.N., N.M.); validation (R.E.G., D.E., N.W.); visualization (N.W., M.He., M.Hi.); writing—original draft (D.E., R.E.G., N.W., C.K., N.M., M.He., M.Hi.); writing—review and editing (D.E., R.E.G., N.W., T.N., N.M., M.Hi., M.He.).


Clinical Trial Statement

Ethical approval was provided by the local ethics committee (21-0475, LMU Munich, Germany).




Publication History

Received: 27 January 2025

Accepted: 31 May 2025

Article published online:
30 June 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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