Pearls and pit-falls
Authors: Emma Tubæk Nielsen, MD., Caroline Lilja, MD., and Magnus Avnstorp, MD.
- The donor site is easily hidden medially of the thigh, making subsequent scarring less visible.
- If the innervation is preserved, the flap can be used for dynamic facial reconstruction aiming to preserve facial expressions.5
- Morbidity at the donor site is relatively low.7
- When denervated, the flap will atrophy over time, which improves the aesthetics and contour of the flap and diminished the need for subsequent procedures.6
- The atrophy and increased contouring of the flap is especially desirable in pediatric patients, where growth plays a major role in the outcome over time.5
- Reduction in length of the scar at the donor site can be achieved using endoscopic subcutaneous dissection when harvesting the gracilis muscle.1
- The skin flap can be designed both as a longitudinal or transverse elliptical flap.1
- When used in facial reconstructions, normal muscle tension should be maintained to ensure maximum muscle survival.1
- There is a risk of slow healing and seroma of donor site if increased tension is applied when closing, especially in elderly patients.4
References
- Kim, Jason H. Gracilis tissue transfer. Medscape, Clinical procedures. 24.07.2019. Link:https://emedicine.medscape.com/article/880792-overview#a2
- Fattah A. Y. et al. A three-dimensional study of the musculotendinous and neurovascular architecture of the gracilis muscle: application to functional muscle transfer. Journal of Plastic, Reconstructiv & Aesthetic Surgery, 2013.
- Universitat Autònoma de Barcelona. Dissection in Fresh Cadaver. European Master’s degree in surgical oncology, reconstructive and aesthetic breast surgery (MRBS).
- Buntic, Rudy. The Gracilis Flap. Microsurgeon, Flaps. Link: https://www.microsurgeon.org/gracilismuscle
- Dr Zezo. Gracilis flap. Plastic Surgery Key. 03.03.2017. Link: https://plasticsurgerykey.com/gracilis-flap/
- Franco M. J. et al. Lower Extremity Reconstruction with Free Gracilis Flaps. J Reconstr Microsurg 2017.
- Redette R. J. et al. Limb salvage of lower-extremity wounds using free gracilis muscle reconstruction. Plastic and Reconstructive Surgery 2000.