The spreaded gracilis flap revisited: Comparing outcomes in lower limb reconstruction

Heidekrueger, Paul I.; Ehrl, Denis; Ninković, Milomir; Aung, Tin; Prantl, Lukas; Herter, Frank; Mueller, Camillo; Broer, P. Niclas

doi:10.1002/micr.30245

Cited by 7 publications

(5 citation statements)

References 40 publications

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“…Furthermore, muscle flaps are ideal to obliterate deep dead spaces that commonly remain after radical debridement of ischemic foot defects. The gracilis muscle flap is our workhorse flap in these patients as its harvest does not impede with subsequent remobilization, 45 its size is sufficient for most ischemic foot defects 46 47 and decrease of flap volume due to atrophy allows anatomical surface reconstruction ( Fig. 1A – D ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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Background: Defects at the forefoot frequently require microsurgical reconstruction, however reconstructive failure can lead to results inferior to primary amputation. The purpose of this study was to identify independent factors affecting surgical outcomes and hospitalization time in these patients. Methods: All patients that underwent free flap reconstruction of the forefoot between 2008 and 2019 were reviewed retrospectively. Statistical evaluation included binary logistic regression and correlation analysis. Results: A total of 93 free flap procedures were performed in 87 patients. The most common defect etiologies were acute trauma (30 cases; 32.3%), diabetic foot syndrome (20 cases; 21.5%) and infection (17 cases; 18.3%). Muscle flaps were used in 50 cases (53.8%) and fasciocutaneous flaps were used in 43 cases (46.2%). Major complications occurred in 24 cases (25.8%) including 11 total flap losses and 2 partial flap losses. Minor complications occurred in 38 cases (40.9%). Patients aged 60 years or above were at significant higher risk for major complications (p=0,029). Use of fasciocutaneous flaps (OR: 14.341; p=0.005), arterial hypertension (OR: 18.801; p=0.014) and operative time (min) (OR: 1.010; p=0.029) were identified as individual risk factors for major complications. Two venous anastomoses significantly reduced the risk for major complications (OR: 0.078; p=0.022). Multi resistant bacterial wound colonization (OR: 65.152; p<0.001) and defect size (OR: 1.007; p=0.045) were identified as independent risk factors for minor complications. The median hospital stay was 28 days (7-85 days). Age significantly correlated with the length of hospital stay (r=0.405, p<0.01). Conclusion: Our study identified independent risk factors that might help to make individual decisions whether to target microsurgical forefoot reconstruction or primary amputation. Two venous anastomoses should be performed whenever feasible, and muscle free flaps should be preferred in patients at higher risk for major surgical complications.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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“…In the current literature, defect sizes up to 150 cm 2 are usually defined to be small to moderate. 28,29 We used the ALT-and the GM flaps for defects ranging from 45 to 350 cm 2 . As demonstrated by our group before, by spreading of the epimysium, the free GM flap can be expanded and then cover defects of up to 400 cm 2 .…”

Section: Discussionmentioning

confidence: 99%

“…As demonstrated by our group before, by spreading of the epimysium, the free GM flap can be expanded and then cover defects of up to 400 cm 2 . 3,29 However, the GM flap is limited by a significantly shorter vascular pedicle compared with the LDM-and ALT flap. Therefore, in central defects (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of defects greater than 350 cm 2 , an LDM free flap is the best solution, even though the LDM flap is associated with higher donor site morbidity. 3,[29][30][31][32] The main advantage of the free ALT flap, besides its low donor site morbidity, lies in its versatility regarding design and composition, the possibility to harvest it simultaneous with the resection, and its long vascular pedicle, 33 which was 11.2 (range: 7-15, SD: 2.5) cm on average in our series. A long pedicle becomes especially important in cases of parietal or central defects, and when nearby recipient vessels are not sufficient.…”

Section: Discussionmentioning

confidence: 99%

“…30,40 This enlargement of the flap can be managed by microscopically aided intramuscular dissection of the perimysium. 3,29,30 When using the GM flap as a muscle flap, a split-thickness skin graft for coverage is necessary. To achieve the best results in quality and color, the skin grafts should be taken close to the recipient side.…”

Section: Discussionmentioning

confidence: 99%

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Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

et al. 2019

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Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.

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