Secret Scar Free Gracilis Flap
ABSTRACT The gracilis free flap is a workhorse in plastic surgery. We present a modified technique that relies on a single horizontal thigh-lift-type approach, which (1) gives wide pedicle exposure, (2) provides material for skin grafting, and (3) allows for distal flap transection without an additional incision. Eighteen gracilis free flaps were performed from 2007 to 2009 for lower extremity reconstruction. Complete flap survival was observed in 17 patients with one partial necrosis distally. Our approach allowed access to divide the distal gracilis tendon without a second incision in all cases. The mean scar length was 16 ± 3 cm and no hypertrophic scars were observed. In 15 patients, no visible scar was observed in the upright position, and in three patients, the scar was visible dorsally (2 ± 1 cm). No sensory deficits were observed 6 months postoperatively. In addition, the split-thickness skin graft harvested from the skin paddle was sufficient to cover all defects.
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ABSTRACT: Denervated muscle tissue undergoes morphologic changes that result in atrophy. The amount of muscle atrophy after denervation following free muscle transfer has not been measured so far. Therefore, the amount of muscle atrophy in human free muscle transfer for lower extremity reconstruction was measured in a series of 10 patients. Three-dimensional laser surface scanning was used to measure flap volume changes 2 weeks as well as 6 and 12 months after the operation. None of the muscles transferred was re-innervated.All muscles healed uneventfully without signs of compromised perfusion resulting in partial flap loss. The muscle volume decreased to 30 ± 4% and 19 ± 4% 6 and 12 months, respectively, after the operation, ie, the volume decreased by approximately 80% within a 12-month period.Denervated free muscle flap tissue undergoes massive atrophy of approximately 80%, mostly within the first 6 months.Annals of plastic surgery 03/2013; 72(6). DOI:10.1097/SAP.0b013e318268a8cc · 1.46 Impact Factor
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ABSTRACT: BACKGROUND: Coverage of tissue defects of the lower limbs is a complex problem. Free gracilis muscle flap is a reliable surgical technique and the morbidity of its donor site is considered as minimal. Our retrospective study involved all patients who underwent a free gracilis muscle flap in a reconstructive surgery of the lower limb. To the best of our knowledge, this is the first study to assess comprehensively the aesthetic and functional morbidity of the free gracilis flap donor site. PATIENTS AND METHODS: Thirty-two patients underwent a gracilis muscle free flap in our plastic surgery department, between January 2009 and April 2012, as part of a reconstructive surgery of the lower limb. All medical datas were carried out using computerized records. Aesthetic and functional assessments of the donor site were done by the patient using questionnaires and by a plastic surgeon and a physiotherapist using a clinical evaluation, 6months after surgery. A comparative study between both limbs including the thigh perimeter analysis, an isokinetic study of the knee, a study of the range of motion of hip and knee, and an assessment of the strength of adduction of the hip were conducted. RESULTS: Concerning the aesthetic outcomes, the clinical and subjective scores were satisfactory with a Vancouver score under 1. Five patients had a decrease in the volume of the thigh after surgery. Concerning the functional outcomes, no motor or sensory defects were reported. No statistically significant difference was demonstrated for the range of motion of the hip and knee between both limbs. The strength of hip adduction was not altered by the removal of the gracilis muscle. CONCLUSION: This study confirms the low aesthetic and functional donor site morbidity of the free gracilis muscle flap. The aftermath of the donor area of the flap are very well accepted by patients, which is a sign of good acceptance of the whole reconstruction. Because of these findings and the suitability of the flap at the recipient site, the gracilis muscle free flap should be part of the armamentarium of any reconstructive surgeon.Annales de chirurgie plastique et esthetique 05/2013; DOI:10.1016/j.anplas.2013.04.001 · 0.59 Impact Factor