The Gracilis Free Muscle Flap is More than Just a “Graceful” Flap for Lower-Leg Reconstruction

Jan Jeroen Vranckx; Dominique Misselyn; Gert Fabre; Nicolas Verhelle; Olivier Heymans; Bert Van den hof

doi:10.1055/s-2004-820770

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2004; 20(2): 143-148
DOI: 10.1055/s-2004-820770

The Gracilis Free Muscle Flap is More than Just a “Graceful” Flap for Lower-Leg Reconstruction

Jan Jeroen Vranckx¹ , Dominique Misselyn¹ , Gert Fabre¹ , Nicolas Verhelle² , Olivier Heymans² , Bert Van den hof¹

¹Departments of Plastic and Reconstructive Surgery, KUL-Leuven University Hospital, Leuven, Belgium
²Departments of Plastic and Reconstructive Surgery, University of Liege, Belgium

Abstract

In 60 consecutive cases, a gracilis free muscle flap was used to reconstruct defects in the lower extremity. Although the harvest of the gracilis free flap is straightforward, the flap is not frequently considered as a valid option for reconstruction because of its “gracile” shape. Hence, it is not considered voluminous enough to cover defects of significant size in the lower leg. However, once the epimysium is separated, the muscle flap spreads out and covers a large surface area, large enough to reconstruct wide rectangular wounds or extended spindleshaped defects. Especially in young patients, the volume of the gracilis muscle is much larger than expected from its descriptive but misleading name. Often it is precisely this patient population that gets involved in motorcycle accidents or traumas caused by contact sports.

For the treatment of Gustilo type III open tibia fractures with moderately large-sized soft-tissue defects and for chronic lower leg defects with osteomyelitis, the gracilis muscle flap is an excellent choice. Fifty-nine out of the 60 flaps in long-term follow-up (minimally 3 years) fully healed. The pedicle can be more than 7 cm in length when the final dissection under the long adductor muscle is carried up to the origin at the deep femoral vessels. The functional and aesthetic outcomes at the donor site at the inner thigh are minimal, compared to alternative transfers for such defects, while the reconstructive features of the gracilis muscle flap are excellent.

KEYWORDS

Gracilis muscle - free muscle transfer - lower extremity reconstruction

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References

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B Van den hofM.D.

Department of Plastic and Reconstructive Surgery, KU-Leuven University Hospitals

Leuven 3000, Belgium