The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Abstract

Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

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

“…This study discloses a trend toward reduced surgical site complications on the medial thigh donor site applying CINPT, even though TMG flaps of significantly larger size were utilized for free flap breast reconstruction. This is elemental, since one of the characteristic drawbacks of the TMG flap is its small size, which frequently necessitates lipo-fillings for volume augmentation [ 8 ]. Our preliminary results therefore cautiously support the application of CINPT to mitigate surgical site complications on the donor site in TMG flap breast reconstruction.…”

“…TMG flap breast reconstruction was performed according to an in-hospital standardized protocol for both groups by senior board-certified surgeons in our institution. The surgical procedure was published in detail [ 8 ]. Donor site closure was performed in three layers with absorbable suture material.…”

“…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.…”

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

“…TMG flap breast reconstructions were performed according to a standardized in-house protocol, applying a two-team approach of simultaneous flap harvest and recipient site preparation. The optimized surgical technique for TMG flap harvest has been published previously [6]. All bilateral breast reconstructions were performed in two separate surgeries with a distance of at least 2 months between the procedures.…”

“…The transverse musculocutaneous gracilis (TMG) flap from the thigh has been utilized for both unilateral and bilateral breast reconstruction. The reliable anatomy with no need for preoperative imaging, the ease of flap raising, the quality and plasticity of the soft tissue as well as the excellent outcome of the breasts with appealing shape and bodyappropriate volume represent various advantages of the TMG flap [6][7][8]. However, limited evidence exists regarding sensation, function and aesthesis of the donor thigh in TMG flap breast reconstruction.…”