Donor Site Morbidity in Unilateral and Bilateral Transverse Musculocutaneous Gracilis (TMG) Flap Breast Reconstruction: Sensation, Function, Aesthesis and Patient-Reported Outcomes

Abstract

The transverse musculocutaneous gracilis (TMG) flap has become a popular choice for breast reconstruction. This study aimed to compare the donor site morbidity in unilateral and bilateral procedures. Patients receiving a TMG flap (January 2008–October 2019) were invited to a follow-up and grouped according to unilateral (UL group) or bilateral (BL group) breast reconstruction. Outcome criteria included sensation, function and aesthesis of the thighs. Patient-reported outcomes were surveyed using validated questionnaires. The number and kind of refinement procedures for aesthetic purposes on the donor thighs were evaluated. Thirty-eight patients with 59 TMG flaps were included in the study (UL group: n = 17, BL group: n = 21). Normal to slightly diminished superficial skin sensation was maintained in most of the thigh skin (98.4%). Strength and mobility were without impairment in >80% of the thighs in both groups. Thigh symmetry was achieved in both groups. Symmetrisation procedures were significantly more often performed in the UL group (p = 0.005). The total number of refinement procedures was similar in both groups. Patient-reported outcomes were similar with good appearance of the thighs and scars, excellent function and low pain levels. The TMG flap offers excellent function and sensation on the donor thigh. Thigh symmetry and good patient satisfaction may be achieved in both unilateral and bilateral breast reconstructions.

Management of donor‐site complications after breast reconstruction with the transverse musculocutaneous gracilis flap: Proposal of a treatment algorithm

“…Overall, the literature demonstrates a similarly low donor‐site morbidity of the TMG flap in comparison to other commonly used free flaps such as the DIEP‐, and profunda artery perforator (PAP) flap (Cho et al, 2020; Siegwart, Bolbos, Tapking, et al, 2021; Tomouk et al, 2017). Although the donor‐site morbidity of the TMG flap has been extensively studied, we were unable to identify studies outlining strategies for a standardized management of various donor‐site complications (Craggs et al, 2014; Siegwart, Bolbos, Haug, et al, 2021; Siegwart, Bolbos, Tapking, et al, 2021; Siegwart, Fischer, Diehm, et al, 2021). This study aims to fill this gap and provides an overview of encountered donor‐site complications, associated risk factors and their management in a large series of TMG flaps.…”

“…However 15 of 16 patients ( 94 %) were moderately to very happy with the scar position, despite the scar being visible while wearing underwear in 12 patients ( 78 %). In their series of 59 TMG flap donor‐site scars Siegwart et al describe the necessity of scar correction in six patients ( 10.1 %) and dog ear excisions in 5 ( 8.4 %) patients (Siegwart, Bolbos, Haug, et al, 2021). Pülzl et al (2011) reported on one patient who adapted her sporting activities because of traction on the donor‐site scar and explained that sports requiring stretching of the legs can pose problems.…”

“…Fansa et al (2008) confirmed they did not observe any labial spreading in their series of 73 donor‐sites. Siegwart, Bolbos, Haug, et al (2021) report labial spreading in 4 ( 7.9 %) out of 59 donor‐sites as a consequence of extensive soft tissue harvest and scar contracture. Pülzl et al surveyed minor changes in the genital region in 11% of their patients, and Craggs et al report genital changes in 24% of their patients (Craggs et al, 2014; Pülzl et al, 2011).…”

“…Slight asymmetry of the donor‐site can frequently be observed in unilateral breast reconstructions with the TMG flap. Pülzl et al measured the mean divergence of thigh circumference in unilateral TMG donor‐sites was 2.4 cm (Pülzl et al, 2011; Siegwart, Bolbos, Haug, et al, 2021). Although 5.6% of their patients reported an asymmetry of the thighs postoperatively, none of those patients requested surgical correction.…”

The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction

“…The TMG flap is appreciated for its reliable anatomy, convenient surgical procedure, low donor site morbidity, and the appealing look of the reconstructed breast [ 8 , 9 ]. However, harvesting the TMG flap, including a horizontal soft tissue island and part of the gracilis muscle, creates an extensive wound on the medial thigh.…”