Lower Extremity Reconstruction with Free Gracilis Flaps.
Research article published in Journal of reconstructive microsurgery (2016)
Abstract
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 sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
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...
Why This Matters for Hirudotherapy
This single-surgeon retrospective review of 24 free gracilis flaps for lower extremity reconstruction reported a 92% flap success rate and 92% limb salvage rate, with low donor-site morbidity. Its relevance to ASH is contextual at best: lower extremity free flap reconstruction is a surgical setting where medicinal leeches are sometimes used adjunctively to manage venous congestion in compromised flaps. However, the article does not mention leeches, hirudotherapy, venous congestion, or flap salvage adjuncts. The study provides no data on leech therapy itself, and the connection is limited to a shared clinical context in which hirudotherapy might occasionally be applied.
Citation
Lower Extremity Reconstruction with Free Gracilis Flaps.
Franco et al. · Journal of reconstructive microsurgery, 2016
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