Versatility of the Gracilis Free Flap: Experiences and Technical Innovations after 140 Flap Transfers

The gracilis muscle is used and described with several variations as a free flap in reconstructive surgery. Modifications allow the muscle to be used in expanding indications (such as breast reconstruction, Poland's syndrome, filler facial material, and defect coverage).

These authors retrospectively analyzed a consecutive series of 140 free gracilis flaps, describing new technical details, such as a split gracilis and the different possibilities for arterial or venous additional anastomoses and flow-through designs. The possibilities of endoscopically-assisted flap harvesting were demonstrated, as well as harvesting through the groin crease, and the flap's value for emergency free tissue transfer. Further applications by radical trimming and thinning of the muscle were discussed. A skin island oriented in a transverse fashion in selected cases was also ideal for immediate skin-sparing mastectomy reconstruction.

The functional outcomes, as well as aesthetic results, were satisfactory in more than 88% of cases. The total failure rate was less than 3%, and the microsurgical revision rate less than 16%. The advantages established the gracilis flap as a first choice for free tissue transfer for the authors for defect coverage and some expanded new indications.