Gracilis Myocutaneous Flap: Adding to the Armamentarium of Complex Sacrococcygeal Defect Reconstruction

Abstract

Background With increasing radicality of rectal cancer surgeries, the postoperative defects are becoming more complex. This demands an ideal reconstructive option with minimal morbidity to the patient. Although vertical rectus abdominis myocutaneous (VRAM) flap is the commonly used flap, gracilis myocutaneous flap is increasingly being performed to avoid morbidity associated with VRAM flap. Results We share our experience about two of our patients treated for rectal malignancy with pelvic exenteration who were reconstructed immediately with pedicled gracilis myocutaneous flap. Both the patients had an uneventful postoperative recovery period and were discharged on postoperative day 10. During follow-up period both patients had a healthy flap with no evidence of recurrence. No perineal hernias or gross dehiscence of skin closure occurred. Conclusion Gracilis myocutaneous flap has its own place with unique advantages adding to the armamentarium of reconstructive options for complex perineal defects, thereby avoiding the morbidity associated with VRAM flap. It stands as a reliable alternative in patients where VRAM cannot be used.

Outcomes of Free Flap Transfer in Facial Reanimation: A Review

“…20 Another benefit of the gracilis flap is that, due to its size, larger sections of the muscle can be harvested for more severe facial paralysis or reconstruction requirements in other areas of the body. 21 The LD flap transfer can also be used for facial reconstruction as it provides a significant quantity of soft tissue required for flap transfer, as well as desirable results in relation to skin color, texture, shape, and healing. 22,23 Less commonly used muscles for facial construction include the superficial temporal fascial flap, 24 the free rectus abdominis myocutaneous flap, 25 the rectus femoris flap, 26 and flexor carpi radialis forearm flap.…”

Mesenchymal Stem Cells and Regenerative Therapy with Bilateral Gracilis Flaps for Perineal Reconstruction of a Wound Infection in the Setting of Anal Squamous Cell Carcinoma

“…6 Many myocutaneous flaps are used, including vertical rectus abdominis muscle (VRAM), gluteal, thigh, V-Y, and gracilis flaps. 7 However, wound infections can complicate the use of these flaps for patients with HIV infection and prior radiation therapy compared with immunocompetent patients and those without a history of radiation therapy. In addition, this patient population often experiences poor wound healing due to decreased ability to mount an inflammatory response.…”

“…In the event that these complications occur, surgeons often place myocutaneous flaps for perineal reconstruction, which can improve outcomes 6 . Many myocutaneous flaps are used, including vertical rectus abdominis muscle (VRAM), gluteal, thigh, V-Y, and gracilis flaps 7 . However, wound infections can complicate the use of these flaps for patients with HIV infection and prior radiation therapy compared with immunocompetent patients and those without a history of radiation therapy.…”