The Gracilis Free Flap Is a Viable Option for Large Extremity Wounds

Background Traditionally, the gracilis free flap is used for coverage of small-to medium-sized wounds (<50 cm²) or as a functional muscle transfer. The purpose of this study is to examine the use of the gracilis free flap in the reconstruction of large extremity wounds (>100 cm²). Methods We retrospectively reviewed records of 34 patients who underwent extremity soft-tissue reconstruction using gracilis free flaps for wounds larger than 100 cm² from 1998 to 2016. The primary outcome was overall flap success rate. Secondary outcomes were rates of major and minor complications. Mean defect size was 145 cm² (range, 104-240 cm²). Seven flaps covered defects greater than 175 cm². Indications were tumor extirpation (n = 18) and traumatic/posttraumatic wounds (n = 16). The most common time period for flap coverage was immediately (3 days or less) after the defect was created (n = 14). Most flaps were solely muscle (n = 28) and were used for lower extremity or foot coverage (n = 29). Results The overall success rate was 94%. Major and minor complications occurred in 5 and 13 cases, respectively. The most common major complication was unplanned reoperation (n = 5), and the most common minor complications were partial skin graft loss (n = 3), partial flap necrosis (n = 3), and planned recipient-site reoperation (n = 5). Conclusions Reconstruction of large extremity wounds using the gracilis free flap showed a 94% success rate with few major complications.