The extended gracilis muscle flap for reconstruction of the lower leg

• Published in: British journal of plastic surgery Vol. 48; no. 6; pp. 353 - 359
• Main Authors: Holle, Jürgen, Worseg, Artur P., Kuzbari, Rafic, Alt, Andreas, Wuringer, Elisabeth
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-09-1995; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Chronic Disease; Compartment Syndromes - surgery; Female; Fractures, Open - surgery; Humans; Leg - surgery; Male; Medical sciences; Middle Aged; Muscle, Skeletal - anatomy & histology; Muscle, Skeletal - transplantation; Osteomyelitis - surgery; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Tibial Fractures - surgery; Human; Skin disease; Rectus medialis muscle; Treatment; Substance loss; Surgery; Free flap; Lower limb; Soft tissue; Anatomical reconstruction
• ISSN: 0007-1226; 1465-3087
• DOI: 10.1016/S0007-1226(95)90044-6

The width of the gracilis muscle was measured before and after removal of the epimysium in 10 fresh cadavers. The average extent of muscle widening achieved by epimysium removal was over 100% (mean 112.6%; standard deviation 11.9%). This extended muscle flap enabled us to cover successfully even large soft tissue defects measuring up to 300 cm
2.
In 27 consecutive patients, soft tissue defects of the lower leg with exposed bone have been repaired by free tissue transfer of a gracilis muscle flap, covered with split skin grafts. The advantages of the gracilis muscle flap were the low donor site morbidity with almost no recognisable functional loss, the easy surgical access, the thin and flat shape of the muscle, and its adequate size after excision of the epimysium. Reconstruction with a gracilis muscle flap resulted in an inconspicuous, stable, and flat contour of the lower leg.
The entire length of the vascular pedicle of the gracilis muscle was easily harvested in our patients by routinely dissecting the pedicle on both sides of the adductor longus muscle.