THE GRACILIS FREE-FLAP REVISITED - A REVIEW OF 25 CASES OF TRANSFER TO TRAUMATIC EXTREMITY WOUNDS

Trauma to the extremities often results in a complex bony and soft-tis sue injury requiring free flap reconstruction, Muscles from various bo dy sites have been used in extremity reconstruction since the early 19 70s, The gracilis muscle is usually not considered the first choice fo r free flap reconstruction of these defects. It is usually relegated t o small defects or used to reanimate the face, Our purpose is to prese nt our experience with the gracilis muscle as a first-choice flap in r econstruction of traumatic extremity defects, A retrospective review o f all gracilis muscle free flap transfers for traumatic extremity woun ds between 1988 and 1995 at the Naval Medical Center Portsmouth was pe rformed, Twenty-five patients age 20 to 71 years (mean, 29.7 years) un derwent 26 free flaps to the lower leg, ankle, foot, or forearm to cov er traumatic wounds. Defects ranged in size from 3 x 3 cm (9 cm(2)) to 13 X 18 cm (234 cm(2)), with a mean of 75.5 cm(2). There were no flap losses and all wounds healed, Nine patients experienced 11 complicati ons, which consisted of minor wound separation (16%), wound infection (12%), partial or complete loss of split-thickness skin graft (8%), th rombosis of graft with successful revascularization (4%), and nonunion of an underlying fracture (4%). Our overall success rate for gracilis free flap reconstruction of traumatic wounds is 100%, The gracilis fr ee muscle flap has become our first option for tissue coverage in trau matized extremities, It leaves minimal functional defect limited to th e side of the primary injury and provides a good cosmetic result, It c an cover large defects when the epimysium is cut, and allows an epidur al block to be performed for sympathectomy effect and pain control in the affected extremity during the immediate postoperative period.