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Background: The use of free gracilis muscle flaps in reconstructive surgery of the lower leg is common practice to cover defects. However, there is still a lack of understanding of the morphometric changes that occur in the transferred muscle and area of interest over time, particularly the characteristic volume decrease that is observed over the course of the first year. This study aimed to assess volume changes in patients with free gracilis muscle flap reconstruction following infection, trauma, or malignancies of the lower extremity. Methods: Three-dimensional surface imaging was performed intraoperatively after 2 weeks, 6 months, and 12 months with the Vectra H2 system. A total of 31 patients were included in this study and analyzed. Results: There was an average volume increase of 146.67 ± 29.66% 2 weeks after reconstruction. Compared to this volume increase, there was a reduction of 108.44 ± 13.62% after 12 months (p < 0.05). Overall, we found a shrinkage to 85.53 ± 20.14% of the intraoperative baseline volume after 12 months. Conclusions: The use of non-invasive 3D surface imaging is a valuable tool for volume monitoring after free flap reconstruction of the lower extremity. The free gracilis muscle flap undergoes different phases of volume change over the first year, with the greatest influence on overall change being the development and decongestion of edema. Precise initial surgical tailoring is crucial for optimal long-term functional and cosmetic results. [ABSTRACT FROM AUTHOR]

Skin-grafted free gracilis muscle flaps are commonly used for lower extremity reconstruction. However, the loss of sensory function may lead to increased patient morbidity. This study prospectively analyzed the sensory and neuropathic pain outcomes of neurotized skin-grafted free gracilis muscle flaps used for the reconstruction of lower extremity defects. Patients undergoing lower extremity reconstructions between 2020 and 2022 with neurotized skin-grafted free gracilis muscle flaps were prospectively enrolled. Sensation was assessed at 3, 6 and 12 months postoperatively using monofilaments, two-point discrimination, a vibration device, and cold and warm metal rods. Sensations were tested in the center and periphery of the flaps, as well as in the surrounding skin. The contralateral side served as the control. Patients completed the McGill pain questionnaire to evaluate patient-reported neuropathic pain. Ten patients were included. At 12 months postoperatively, monofilament values improved by 44.5% compared to that of the control site, two-point discrimination, cold detection, warmth detection, and vibration detection improved by 36.2%, 48%, 50%, and 88.2%, respectively, at the reconstructed site compared to those at the control site. All sensory tests were significantly better than 3 and 6 months values (p < 0.05), but remained significantly poorer than the control site (p < 0.05). Sensation in the central flap areas were similar to peripheral flap areas throughout the follow-up period (p > 0.05). The surrounding skin reached values similar to the control site at 12 months (p > 0.05). Moreover, 50% of patients reported neuropathic pain at 3 months postoperatively, 40% at 6 months, and 0% at 12 months (p < 0.05). Mechanical detection, vibration detection, temperature detection, and two-point discrimination significantly improved over time but without reaching normal sensory function at 12 months postoperatively. Neuropathic pain resolved at 12 months. [ABSTRACT FROM AUTHOR]

Purpose: Gracilis muscle flaps are useful to cover defects of the hand. However, there are currently no studies describing outcome measurements after covering soft tissue defects using free flaps in the hand. Aim: To analyze mid-term results of gracilis muscle flap coverage for defects on the hand, with regard to functional and esthetic integrity. Methods: 16 patients aged 44.3 (range 20–70) years were re-examined after a mean follow-up of 23.6 (range 2–77) months. Mean defect size was 124 (range 52–300) cm2 located palmar (n = 9), dorsal (n = 6), or radial (n = 1). All flaps were performed as microvascular muscle flaps, covered by split thickness skin graft. Results: Flaps survived in 15 patients. 6 patients required reoperations. Reasons for revisions were venous anastomosis failure with total flap loss (n = 1) requiring a second gracilis muscle flap; necrosis at the tip of the flap (n = 1) with renewed split thickness skin cover. A surplus of the flap (n = 2) required flap thinning and scar corrections were performed in 2 patients. Mean grip strength was 25% (range 33.3–96.4%) compared to the contralateral side and mean patient-reported satisfaction 1.4 (range 1–3) (1 = excellent; 4 = poor). Conclusions: Gracilis muscle flaps showed a survival rate of 94%. Patients showed good clinical outcomes with acceptable wrist movements and grip strength as well as high reported satisfaction rates. Compared to fasciocutaneous free flaps, pliability and thinness especially on the palmar aspect of the hand are advantageous. Hence, covering large defects of the hand with a gracilis muscle flap can be a very satisfactory procedure. Level of evidence: IV observational. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to perform morphometry of the gracilis muscle and understand the topographical basis of the entry of its pedicles. Methods We studied forty-four cadaveric lower extremities fixed in formalin. The length and width of the gracilis were measured at three locations: the origin, midpoint, and musculotendinous junction. The topographic location of the gracilis pedicles was also studied. Results The gracilis muscle’s length was 369.9±34.1 mm and 359.6±29.6 mm over the right and left sides. The width of right gracilis was 25±8.4 mm, 20.4±6.2 mm and 10.6±5.6 mm at the origin, midpoint and at the musculotendinous junction. The same over the left side were 26.7±8.6 mm, 20.6±9.1 mm and 10.4±6.4 mm respectively. The number of gracilis ranged from one to three. The location of first pedicle was 93.6±35.6 mm and 68.9±35.8 mm away from the pubic tubercle on the right and left sides, respectively. The second and third pedicles were entering at a distance of 153.1±38.8 mm and 101.3±20.8 mm, 214.6±86.8 mm and 145.3±124.4 mm over the right side and left side. The accessory head of the origin of the gracilis was observed in only one cadaver (2.3%), which originated from the adductor longus. Conclusions It is believed that the morphological data of the gracilis and its neurovascular pedicles will be enlightening to the operating surgeon. They will guide the procedures for reconstructive plastic surgery.

The conventional approach to harvest of the gracilis muscle flap necessitates a medial thigh incision that is often related to several donor site complications. In this report we describe the robotic harvest of the free gracilis muscle flap in order to reduce the morbidity associated with the open incision. Through three ports, the robotic system (Da Vinci Xi, Intuitive Surgical) enables precise dissection of the gracilis muscle, the vascular pedicle, and the obturator nerve; thus, enhancing surgical control, optimizing visualization through magnification, aiding in detailed vascular pedicle dissection and minimizing human error. We believe that the technique of totally robotic harvest of the free gracilis muscle flap, herein introduced, is a feasible and effective approach, and confers specific advantages over traditional harvest technique. [ABSTRACT FROM AUTHOR]

The sartorius muscle transposition flap is the traditional method of femoral vessel coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. However, if the groin has undergone radiotherapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin at its insertion and intimately related to several nerves. The gracilis muscle has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node. She underwent modified Nigro protocol chemoradiation treatment, which included radiation to the inguinal node basins. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation. Despite a subsequent groin wound infection, the gracilis muscle flap remained viable and successfully protected the major vessels. We report the gracilis muscle flap as a viable alternative to the sartorius transposition muscle flap for femoral vessel coverage after oncologic superficial inguinal lymphadenectomy in the irradiated groin. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical effect of free gracilis muscle flap grafting for repairing incision infection accompany with cerebrospinal fluid (CSF) leakage after occipital craniocerebral surgeries. Methods This study was a retrospective and observational study. From January 2017 to December 2021, 4 patients with incision infection accompany with CSF leakage occipital craniocerebral surgeries were admitted to the Plastic and Burn Department of the Second Affiliated Hospital of Air Force Medical University. All the patients were treated with local debridement combined with free gracilis muscle flap free grafting repair. Results Four patients had successful gracilis graft and without complications such as reinfection and CSF leakage. Follow-up for 3 to 10 months after operation showed that the heads had good appearance and no without significant scar hyperplasia in the donor area. Conclusion The gracilis muscle flap transplantation for repairing incision infection accompany with CSF leakage after posterior occipital craniocerebral surgery, can minimize the recurrence of reinfection and CSF leakage, achieve good functional recovery effect and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

An iatrogenic urethral perineal fistula can cause challenging problems for surgical reconstruction. In most cases, treatment is performed in three steps: double-diversion urinary and intestinal diversion, closure, and diversion. The augmented posterior urethroplasty interposition with a gracilis muscle function flap for the repair of the perineal gap was successful. We reviewed a patient aged 42 years old male who presented to the urology department with leakage of urine per perineum after abdominal perineal resection and end colostomy due to anal-rectal malignancy 2 months earlier. He subsequently had a gapped perineal wound post abdominal-perineal resection (APR). Suprapubic Cystostomy and urethral catheter and a cystoscope showed a normal verumontanum, and there was a left para-verumontanum fistula approximately 3 cm in size that communicated with the perineum gapped wound. Tissue histology revealed chronic inflammation. Augmentation posterior urethroplasty with interposition of the gracilis muscle flap. Urethral perineal fistulas have different etiologic origins, such as inflammatory, neoplastic, traumatic, or iatrogenic injury. Treatment is performed in three steps: double diversion urinary and intestinal, closure, and no diversion. In our case, the perineal gapped wound allowed us to access the posterior urethra and this potential space for gracilis muscle interposition, aiming to facilitate fistula repair and cover perineal gap wound repair. Posterior urethral perineal fistulas can be repaired by a gracilis muscle flap, providing acceptable treatment results. However, more research is needed in fistula studies evaluating patients' sexual and urinary efficiency to achieve more accurate results. • Gracilis muscle flap • augmented posterior urethroplasty • Cystoscopy • V Y Gluteal flap [ABSTRACT FROM AUTHOR]

Abstract Background Fournier’s gangrene is an acute soft tissue necrotizing infection involving the perineum and the external genitalia which can result in a major loss of the scrotal wall with exposure of the testicles. Reconstruction of such major defect is quite challenging; the use of pedicled gracilis muscle flap helps to create an aesthetically acceptable scrotum with minimal donor site morbidity. Case presentation We described the case of a 60-year-old man with a large scrotal loss from Fournier’s gangrene following bladder outlet obstruction and perineal abscess. He had multiple debridement and reconstruction with pedicled left gracilis muscle flap with a good aesthetic and functional post-operative outcome. The major challenge encountered was the loss of the skin graft as a result of the retraction of the muscle flap due to too early ambulation; this can thus be avoided by adequate pre-operative counseling and enforcing bed rest. Conclusions The use of gracilis muscle flap in the reconstruction of large scrotal defect described in this report has the additional advantage of creating a pliable and soft feel like that of the original scrotum with minimal donor site morbidity.

Background: Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain. Where nerve reconstruction is not possible, muscle transfers remain as secondary reconstructive procedures., Methods: Three patients with anterior deltoid palsy after proximal humerus fixation received a free functional gracilis transfer to the shoulder. Postoperatively, patients underwent biofeedback-based rehabilitation. Before and after the intervention, subjective complaints, pain level, and active range of motion (ROM) were recorded. At the final follow-up, patients completed a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire., Results: The surgery was successful in all patients, with first muscle signals registered through surface electromyography approximately four months postoperatively. At the last follow-up (>3 years), the patients showed improved shoulder stability and pain scores. In two patients with preoperative restrictions, active ROM improved. The DASH score showed minimal to no disability in two patients and moderate disability in the third. Two patients voiced satisfaction with the restoration of the ventral bulk of the shoulder., Conclusions: Free functional gracilis muscle transfer is a novel approach for secondary reconstruction in patients with anterior deltoid atrophy who do not qualify for nerve intervention. It addresses shoulder instability and pain and may improve active ROM. The addition of fresh muscle tissue to the ventral shoulder can improve its natural contour and prevent protrusion of the humeral head., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). Methods: PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. Results: Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], −3.4–12.3%; I 2 = 0%), 21.8% overall complications (95% CI, 15.8–27.7%; I 2 = 0%), 8.0% limb loss (95% CI, 1.9–14.1%; I 2 = 0%), 15.4% graft loss (95% CI, 5.0–25.3%; I 2 = 37.9%), and 7.4% 30-day mortality (95% CI, −.9–15.6%; I 2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1–28.2%; I 2 = 0%), 23.2% (95% CI, 11.2–34.5%; I 2 = 10.2%), and 18.0% (95% CI, −3.537.8%; I 2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, −4.237.2%; I 2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI,.6–39.1%; I 2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, −6.1–16.6%; I 2 = 0%). Conclusions: The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps. [ABSTRACT FROM AUTHOR]

This is a case report of 35-year-old male patient, who underwent abdominoperineal resection for rectal cancer. There was postoperative wound complication which resulted in the formation of sinus in the perineal wound. During excision of the sinus tract, there was injury to the posterior urethra which leads to the formation of urethrocutaneous fistula presenting as urinary incontinence. These findings were confirmed by ascending urethrogram and cystoscopy. We describe the use of gracilis muscle flap as support and cover for buccal mucosal graft which has been used for the repair of the posterior urethral injury. On removal of Foley's catheter after 3 weeks of the surgery, there was no leakage of urine from the perineal wound, and the patient was continent. The highly vascularized muscle flap is beneficial in patients with a poor graft bed secondary to prior radiotherapy, avoiding urinary diversion in most patients.

Orbital exenteration is a disfiguring procedure that often results in free tissue transfer for reconstructive purposes. The reconstructive focus is the obliteration of dead space while sparing the nasal airway, particularly if the medial orbital wall was resected. Prolapse of transferred tissue into the nasal airway may cause breathing difficulties drastically compromising quality of life. The objective of this study was to demonstrate the effectiveness and feasibility of temporary nasal septum splints as mechanical support for transferred tissue, to prevent airway obstruction. This novel application technique was employed in three patients between 2017 and 2018. No flap loss or sino‐orbital fistulas were observed. On postoperative MRI and endoscopy, a patent nasal airway was observed at all times. Temporary nasal splinting in combination with free tissue transfer proved to be a simple, but effective reconstructive option for securing the nasal airway following orbital exenteration with resection of the medial orbital wall. [ABSTRACT FROM AUTHOR]

We present the case of a 48-year-old patient with a recurrent rectovaginal fistula, who we treated surgically by transposing the gracilis muscle. The patient with a history of ulcerative colitis underwent colorectal resection with mechanical anastomosis and diverting ileostomy for rectal cancer. She was subsequently treated by radiation and chemotherapy. Six weeks later, the ileostomy was removed, but afterwards the patient developed a recto-vaginal fistula. A new diverting ileostomy was performed. After eight months, a transvaginal surgical procedure was performed, and the diverting ileostomy was closed after four months. Two years after the last surgery, the patient performed an MRI scan, which revealed the relapse of the rectovaginal fistula. This time the patient was reoperated using a flap of the gracilis muscle interposed between the rectum and the vagina, but the patient refused any diverting stoma. The rectovaginal fistula relapsed again after thirteen days. Fortunately, after six months of intensive systemic and local treatment with aminosalicilic-5-acid, the fistula closed by itself. Our conclusion is that with a well-managed medical treatment, the gracilis flap, because of its good vascular supply, could be successfully used to treat rectovaginal fistulas even in patients with ulcerative colitis who underwent rectal surgery and radiation therapy for cancer.

Abstract Background Critical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization. Case presentation A 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage. Conclusion Even in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage.

This is a case report of 35-year-old male patient, who underwent abdominoperineal resection for rectal cancer. There was postoperative wound complication which resulted in the formation of sinus in the perineal wound. During excision of the sinus tract, there was injury to the posterior urethra which leads to the formation of urethrocutaneous fistula presenting as urinary incontinence. These findings were confirmed by ascending urethrogram and cystoscopy. We describe the use of gracilis muscle flap as support and cover for buccal mucosal graft which has been used for the repair of the posterior urethral injury. On removal of Foley's catheter after 3 weeks of the surgery, there was no leakage of urine from the perineal wound, and the patient was continent. The highly vascularized muscle flap is beneficial in patients with a poor graft bed secondary to prior radiotherapy, avoiding urinary diversion in most patients. [ABSTRACT FROM AUTHOR]

Background  An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods  Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results  Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm 2 , whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm 2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion  Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution. [ABSTRACT FROM AUTHOR]

Background: Goals of lower extremity microvascular reconstruction (LEMR) include the restoration of function, prevention of infection, and optimal cosmesis. Indications for LEMR include large defects that are not amenable to pedicled options, a large zone of injury, and large complex defects. The novice microsurgeon should first master a handful of free flaps to develop an armamentarium of options for addressing such defects. The scope of this review is to provide free flap options for LEMR in any of the thirds of the lower leg. After reading this article, the reader will understand variations, advantages, disadvantages, indications, and tips for raising each of these flaps.Methods: Six most commonly used free flaps for LEMR are described in this paper, including the anterolateral thigh flap (ALT) and its variations, the radial forearm flap (RFFF), the lateral arm flap (LAF), the gracilis muscle flap, the rectus abdominis flap (RAF) and the latissimus dorsi flap and its variations. Indications, advantages, disadvantages and technique tips are discussed for each flap. Moreover, selection of the recipient vessels, preoperative management along with an algorithm are also provided.Conclusions: The ALT flap is a workhorse in covering defects of the leg, foot, and ankle. It's the flap of choice at our institution, especially given the number of traumatic wounds seen as a result of motor vehicles, all-terrain vehicles (ATV), lawnmowers, and gunshot wounds (GSW). At times, the lower extremity zone of injury requires a distant donor site. The RAF can also provide coverage for large soft tissue defects but donor-site morbidity remains its main drawback. The LAF and RFFF provide two pliable options, one that provides pliable soft tissue with minimal donor site morbidity and another that provides a long pedicle. The free gracilis flap is an excellent choice for crossing the ankle joint. Lastly, the free latissimus dorsi is indicated for large defects of the lower extremity independently of the location. [ABSTRACT FROM AUTHOR]

Blunt trauma sustained in traffic accidents can cause significant rectum injury, either intra or extraperitoneal. Severe injuries have high mortality rates and many complications, including pelvic absesses, sepsis, rectal fistulas, stenosis, and rectal incontinence. Following the initial surgical procedure, many reconstructive methods can be used to treat perineal wounds, including gracilis myocutaneus flap, rectus abdominis flap, gluteal flap, perforator flap, posterior thigh flap, groin flap, and pudendal fasciocutaneous flap. NPWT is used to promote formation of granulation tissue, reduce and prepare tissue gap to be covered, improve perfusion through removal of excessive fluid, and reduce bacterial wound colonization. Some of the complications of this method are pain, skin irritation and maceration, tissue necrosis, bleeding, and infection. The success rate of NPWT depends on multiple factors, including patient characteristics, effectiveness of primary surgical procedure and need for further surgical interventions, size and depth of the wound, and proper NPWT application technique. NPWT has shown to reduce total treatment cost due to shorter patient hospital stay, reduction of complication rates, reduction of further surgical interventions, and lower frequency of dressing change compared with standard dressings. In this case study, I present a 53-year-old motorcyclist who was injured in a traffic accident and sustained fracture of the sacrum, rupture of the pubic symphysis, fracture of L5 vertebrae, and penetrant injury to the rectum. Multiple explorative laparotomies, colostomy, and supportive and drug treatment methods were carried out to obtain a successful outcome. [ABSTRACT FROM AUTHOR]

Superficial head and neck vessels are increasingly used in surgical procedures and are especially important in facial transplantation surgeries. We report a variant course of the submental vein observed during a dissection of a 79-year-old-male embalmed cadaver: a left submental vein running caudally across the intermediate tendon of the digastric muscle, separating from the course of the submental artery and emptying directly into the common facial vein in the carotid triangle. Such course may complicate submental island flap harvesting, as well as the graft manipulations and reattachment, since the vein could be damaged during the conventional procedure. This report therefore extends current knowledge of the variations of the vascular anatomy of the head and neck. [ABSTRACT FROM AUTHOR]

The high-voltage electrical injury is not uncommon, but the involvement of the genitalia and the perineum is rare. Our patient is a 29-year-old female with electrical injury from a high-tension wire and had injury to the perineum, genitalia, and lower limbs with negligible involvement of the upper limbs. There was a loss of the lower half of the labia majora and she had a tissue defect on the left side of the perineum. The reconstruction was performed with the use of pedicled gracilis flap with a good outcome.

Purpose: Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula. Methods: We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016. Results: Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort. Conclusions: Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice. [ABSTRACT FROM AUTHOR]

Background There have been significant advancements in lower extremity reconstruction over the last several decades, and the plastic surgeon's armamentarium has grown to include free muscle and fasciocutaneous flaps along with local perforator and propeller flaps. While we have found a use for a variety of techniques for lower extremity reconstruction, the free gracilis has been our workhorse flap due to the ease of harvest, reliability, and low donor site morbidity. Methods This is a retrospective review of a single surgeon's series of free gracilis flaps utilized for lower extremity reconstruction. Demographic information, comorbidities, outcomes, and secondary procedures were analyzed. Results We identified 24 free gracilis flaps. The duration from injury to free flap coverage was ≤ 7 days in 6 patients, 8-30 days in 11 patients, 31-90 days in 4 patients, and > 90 days in 3 patients. There were 22 (92%) successful flaps and an overall limb salvage rate of 92%. There was one partial flap loss. Two flaps underwent incision and drainage in the operating room for infection. Two patients developed donor site hematomas. Four patients underwent secondary procedures for contouring. Our subset of pediatric patients had 100% flap survival and no secondary procedures at a mean 30- month follow-up. Conclusion This study demonstrates the utility of the free gracilis flap in reconstruction of small- to medium-sized defects of the lower extremity. This flap has a high success rate and a low donor site morbidity. Atrophy of the denervated muscle over time allows for good shoe fit, often obviating the need for secondary contouring procedures. [ABSTRACT FROM AUTHOR]

Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. Methods: A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. Results: All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. Conclusions: The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry. [ABSTRACT FROM AUTHOR]