The Gracilis Muscle Flap: A “Work Horse” Free Flap in Diabetic Foot Reconstruction

Shyamsundar, Skanda; Mahmud, Ali; Khalasi, Vishal

doi:10.52547/wjps.10.2.33

Cited by 5 publications

(4 citation statements)

References 23 publications

(15 reference statements)

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“…Although chimeric flaps can be used to reconstruct DFUs with dead cavities, 41 the repaired skin grafts often become bulky and require secondary surgery for debulking, with the risk of damaging the cutaneous nerves during flap harvesting. Free muscle flaps have advantages such as shorter operation time, sufficient size, ability to fill dead cavities, abundant blood supply, strong anti‐infection capabilities, good contour appearance and no damage to cutaneous nerves 17,42,43 . Therefore, combining free muscle flaps with STSGs may be an ideal choice for DFU reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Free muscle flaps have advantages such as shorter operation time, sufficient size, ability to fill dead cavities, abundant blood supply, strong anti‐infection capabilities, good contour appearance and no damage to cutaneous nerves. 17 , 42 , 43 Therefore, combining free muscle flaps with STSGs may be an ideal choice for DFU reconstruction. Mayr‐Riedler et al 44 found that the risk of significant complications in reconstructing the forefoot using free fasciocutaneous flaps is four times higher than that of free muscle flaps, especially in elderly patients with ischaemic defects.…”

Section: Discussionmentioning

confidence: 99%

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Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Chang,

Jian,

Liu

et al. 2024

International Wound Journal

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Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic‐loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle‐sparing (VLMS) flaps and split‐thickness skin grafts (STSGs) in the second stage to repair non‐weight‐bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47–71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF‐36 questionnaire measured pre‐ and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7‐ to 24‐month follow‐up, during which SF‐36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non‐weight‐bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Chang,

Jian,

Liu

et al. 2024

International Wound Journal

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“…This flap is versatile due to the amount of soft tissue available and the consistent vascular supply (Urken, 2012). It is widely used for postoncological breast reconstruction and advanced diabetic foot complications without significant donor site and functional morbidities (Shyamsundar et al, 2021; Siegwart et al, 2021). In head and neck surgery, it was proposed as a valuable alternative in salvage laryngectomies (Jing et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, some interesting findings have been reported by Simsek et al (2017), who used this flap to manage extended orbital exenterations. We preferred the gracilis muscle free flap because of the minimal donor site morbidity and the optimal functional outcome that this option has widely demonstrated in the current literature (Shyamsundar et al, 2021; Siegwart et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Sequential chimeric fibula‐gracilis flap to salvage a complex orbitomaxillary defect: A case report

2023

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Extended maxillectomies with orbital exenteration and facial soft tissue resection need careful planning to achieve satisfactory functional and esthetic outcomes. Only a few solutions provide enough hard and soft tissue on a single pedicle, and only some reconstructive goals might be achievable with a single flap. This paper describes an original inset of the gracilis muscle free flap, used in a vessels depleted patient to salvage a partially failed multi-flap reconstruction after an extensive maxillectomy. A 55-years old man underwent a surgical intervention for a fibrosarcoma of the right maxilla. Due to the disease extension, the resection included right maxilla and palate, the overlying facial soft tissues (including the paranasal, cheek, and infraorbital regions), and the entire orbital content (orbital exenteration). A double flap reconstruction-a free fibula flap and a deep circumflex iliac artery flap-was carried out primarily. However, an intraoperative complication caused a partial flap loss, resulting in a complex tridimensional defect of the orbit and the oral cavity. Therefore, a 18 cm long gracilis muscle free flap was used to fill the defect and save the remaining bony reconstruction. The muscle was inset behind the transplanted bone to seal both the orbit and the oral cavity. No complications occurred after the salvage surgery, with a stable result at the 6-months follow-up. The designed gracilis muscle free flap proved a reliable option for this salvage surgery. However, it could be helpful also in the primary reconstruction of extended maxillectomies in combination with another composite free flap.

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A case report of upper limb loss of substance: Use of functional gracilis free flap, brachioradialis transposition and bioglass for bone regeneration

Gravina

Francesco

Pangrazi

et al. 2022

Trauma Case Reports

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Complex trauma of the upper limb is a common consequence of involvement in serious accidents. Loss of substance including nerve, bone, tendons and vascular defects are challenging surgical issues. A 27- year-old male presented with complex upper limb trauma and loss of a proximal third of the posterior forearm structure as well as loss of active finger extension, ulnar and radial nerve territory anesthesia and ulnar fracture. A composite nerve-tendon-muscle-skin gracilis free flap was retrieved from the contralateral leg, related to tendon transfer of BR to ELP, to supply active hand extension. The patient was required to adhere to intensive post-surgical rehabilitation and monitored for a 3-year follow-up period. Our assessment revealed adequate skin trophism and sufficient muscle strength recovery against resistance (M5). The functional flap associated with tendon transfer was considered an efficient procedure for the management of a complex trauma with loss of posterior interosseous nerve and bone exposition. The free re-innervated gracilis flap may be used to repair complex soft tissue defects with exposed bone and to restore finger extension following severe forearm injuries.

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The Gracilis Muscle Flap: A “Work Horse” Free Flap in Diabetic Foot Reconstruction

Cited by 5 publications

References 23 publications

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Sequential chimeric fibula‐gracilis flap to salvage a complex orbitomaxillary defect: A case report

A case report of upper limb loss of substance: Use of functional gracilis free flap, brachioradialis transposition and bioglass for bone regeneration

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