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The free gracilis muscle flap in achilles tendon coverage and reconstruction
Georg M Huemer1, Lorenz Larcher, Thomas Schoeller
1Linz and Innsbruck, Austria; and Stuttgart, Germany From the Section of Plastic and Reconstructive Surgery, Linz General Hospital; Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart; and Department of Plastic and Reconstructive Surgery, Innsbruck Medical University.
Background:
The Achilles tendon area is a delicate one, and therefore numerous publications describe methods of reconstruction with flaps. In the event of simultaneous tendon loss, suitable methods for tendon reconstruction have to be considered. The authors describe their experience with gracilis muscle flap reconstruction in this difficult area.
Methods:
From March of 2003 until March of 2010, the authors performed a series of 20 patients receiving gracilis flaps for defects in the Achilles region alone or in combination with concomitant tendon loss. The authors retrospectively analyzed the origin and size of the defect, microsurgical success, and early and late complications needing operative treatment, as well as the aesthetic and functional outcome.
Results:
A total of 21 free gracilis muscle flaps were performed in 20 patients. The authors had one complete flap loss that was treated with a second gracilis flap. Follow-up ranged from 3 to 60 months (mean, 12.9 months). In four patients, simultaneous reconstruction of the Achilles tendon was carried out. Early postoperative complications included four hematomas (one at the donor site), two infections, and one skin graft loss, whereas late complications consisted of osteomyelitis and superficial ulceration in two patients, as well as rerupture of the Achilles tendon in one patient. Furthermore, the authors encountered one case of hypertrophic scarring and chronic fistulation at the donor site. Apart from that, functional and aesthetic outcome was judged to be good to excellent by the patients.
Conclusions:
In the authors' opinion, the free gracilis muscle flap provides the surgeon with an exceptional tool for reconstruction in the critical Achilles region. It is appropriate for small and large defects, filling dead space under the tendon and becoming thin within several months. The ability for simultaneous tendon reconstruction due to available tendon graft material is a further strong advantage.
Clinical Question/Level Of Evidence:
Therapeutic, IV.