Experiences of Using the Free Gracilis Muscle Flap and Split Thickness Skin Graft for One-stage Foot Reconstruction

Abstract

Background: Soft tissue reconstruction of the foot is a challenge in plastic surgery. Although many different types of free flaps have been used for foot reconstruction, the choice of an ideal free tissue transfer in complex soft tissue defect reconstruction remains controversial. Aim and objectives: In this paper, we present our experiences of using free gracilis muscle flaps for one-stage foot reconstruction. Materials and Methods: Nine patients underwent reconstruction with the free gracilis muscle flap and split thickness skin graft for foot soft tissue defects. Etiologic factors included trauma (6 patients), diabetes mellitus (2 patients), and chronic ulcer (1 patient). Four patients had concomitant fractures. The size of the gracilis muscle flap ranged from 42 to 88 cm^2 (mean, 64.8 cm^2). The anatomic regions of reconstruction were grouped as dorsum (n=6), ankle (n=2), and plantar foot (n=1). Results: Successful reconstruction was accomplished in all patients. One patient developed venous thrombosis, and there was partial skin graft loss in 2 patients. Longitudinal split of the gracilis muscles was performed in 2 patients for separate wound coverage. The concomitant open fracture in 4 patients healed without osteomyelitis complications. All patients returned to normal ambulation without assistive devices. There were no reported ulcerations in flap regions, and the patients were free of foot pain during the follow-up period. Donor-site wound healing was uneventful, and scarring was unapparent. In all patients, the muscle flap had progressive shrinkage and atrophy, therefore, debulking surgery was not performed. No patient required use of special shoes. Conclusions: The application of the free gracilis muscle flap and split thickness skin graft is a good choice for medium-sized foot defects with or without underlying bone fracture. Free gracilis muscle flaps provide stable coverage and an acceptable appearance without the necessity of secondary debulking surgery during long-term follow-up.