Limb salvage of lower-extremity wounds using free gracilis muscle reconstruction

An extensive series reviewing the benefits and drawbacks of use of the grac ilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and p osttraumatic chronic wounds is reviewed. In addition, the wound size, injur y patterns, problems, and results unique to the use of the gracilis as a do nor muscle for lower-extremity reconstruction are identified. In a 7-year p eriod from 1991 to 1998, 50 patients underwent lower-extremity reconstructi on using microvascular free gracilis transfer at the University of Maryland Shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Med ical Center. There were 22 patients who underwent reconstruction for covera ge of acute lower-extremity traumatic soft-tissue defects associated with o pen fractures. The majority of patients were victims of high-energy injurie s with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuri es were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect Size was 92.2 cm(2). Successful limb salv age was achieved in 95 percent of patients. Twenty-eight patients with prev ious Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis of deep soft-tissue infection . Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successf ul limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a relia ble and predictable tool in lower-extremity reconstruction, with a flap suc cess and limb salvage rate comparable to those in other large studies.