A Retrospective Review of Outcomes and Flap Selection in Free Tissue Transfers for Complex Lower Extremity Reconstruction

Fischer, John P.; Wink, Jason D.; Nelson, Jonas A.; Cleveland, Emily C.; Grover, Ritwik; Wu, Liza C.; Levin, L. Scott; Kovach, Stephen J.

doi:10.1055/s-0033-1343952

Cited by 86 publications

(40 citation statements)

References 22 publications

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“…This analysis revealed that the gracilis flap was the 3 rd most utilized flap after the anterolateral thigh flap and latissimus dorsi flap 14 . Our failure rate is consistent with this and other published reports 12,14,18 . In a retrospective review of 119 free flaps in 114 patients, Fischer et al reported using the gracilis free flap in only 3 (2.5%) cases.…”

Section: Discussionsupporting

confidence: 94%

“…Our flap loss rate of 8% is in line with published reports of free flap survival in lower extremity reconstruction 12,18,19,23 . It is important to acknowledge that while we lost only 2 flaps completely, our 1 partial flap loss led to exposure of critical structures despite the majority of the flap surviving.…”

Section: Discussionsupporting

confidence: 90%

“…The majority of the flaps used in their series were the anterolateral thigh flap (40%) and the rectus abdominus flap (18%). They reported that in 2 of the gracilis flaps there were intraoperative factors that led to major complications requiring reoperation but there was no total flap loss 12 . Given that the free gracilis was only used in 3 cases, it is difficult to draw conclusions of safety and efficacy with regards to this specific flap.…”

Section: Discussionmentioning

confidence: 99%

“…As surgeons became comfortable harvesting the ALT, this flap was found to be reliable and effective in covering open fractures in the lower extremity 9–11 . While the introduction of locoregional propeller and perforator flaps over the last decade has expanded reconstructive options in the lower extremity, free tissue transfer with the ALT flap has remained the predominant technique for coverage of complex lower extremity defects as it avoids the zone of injury, which often limits the utilization of locoregional flap coverage 12–14 . However, despite its popularity, the ALT flap is not without limitations in the coverage of lower extremity defects.…”

Section: Introductionmentioning

confidence: 99%

“…While the gracilis muscle flap has been well described from an anatomic standpoint, the utility of this flap in lower extremity reconstruction is underreported in the literature as it is often considered a secondary or tertiary option 12,14,19,20 . Furthermore, there is a paucity of data on long-term outcomes and revision rates following free gracilis muscle flap reconstruction of lower extremity defects, with reports including pediatric patients specifically lacking in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Lower Extremity Reconstruction with Free Gracilis Flaps

Franco

Nicoson

Parikh

et al. 2016

J reconstr Microsurg

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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 or less 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. Conclusions 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 low donor site morbidity. Atrophy of the denervated muscle over time allows for good shoe fit, often obviating the need for secondary contouring procedures.

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