Objective: Coverage of soft-tissue defects of various sizes by an easy-to-do and reliable free muscle/myocutaneous flap.
Indications: Soft-tissue defects of a size up to 10 x 22 cm. Functional muscle transfer, e.g., biceps muscle replacement.
Contraindications: Poor soft-tissue conditions or lesions on both thighs. No recipient vessels. Inadequate personnel and/or technical resources.
Surgical technique: Approach via a longitudinal medial incision or via the thigh flexion fold. The flap can be designed with or without a skin island. After mobilization from its tendinous part up to its origin, the vascular pedicle is prepared until its origin from the deep femoral artery. After harvesting, transfer is performed by anastomosing and shaping, eventually followed by split-thickness skin grafting.
Postoperative management: Clinical controls and measurement of partial oxygen concentration until day 10. Immobilization for 10 days, if the recipient site is close to a joint. Thrombosis prophylaxis.
Results: During the past 10 years, 254 free gracilis flaps were transplanted. Total flap loss rate was 4.3%, whereas reoperation due to hematoma or partial flap loss was necessary in 13.0%.