Treatment Outcomes Following Reconstruction With a Modified Gracilis Free Flap

Patients with complex defects secondary to traumatic injuries, severe infection or locally advanced malignancies present a therapeutic challenge. Surgical techniques continue to evolve that focus on reducing flap associated morbidity. The gracilis free flap is a workhorse in reconstructive microsurgery, and its design can be adjusted to optimise donor site form and function. This study's objective was to determine treatment outcomes following reconstruction using a modified gracilis muscle free flap termed 'the gracilette'.

Adult patients received treatment at the Princess Alexandra Hospital and the data were prospectively recorded. Statistical analyses were performed to examine the relationships between patient demographics, clinical characteristics, reconstructive features and treatment outcomes. The primary outcome was free flap failure. Secondary outcomes included acute microvascular compromise, return to theatre and donor site complication.

Eleven patients were treated between June 2019 and December 2023. Harvested flap dimensions varied between 7 × 4 cm and 10 × 6 cm (< 60 cm²). The median patient age was 45.8 years, post-operative length of stay 9 days and follow-up period 20.4 months. There were no returns to theatre for acute microvascular issues and no partial or total flap failures. Two patients developed donor site seromas requiring percutaneous drainage. Smoking was a significant predictor of an adverse outcome on multiple logistic regression modelling.

In this study, the gracilette was a reliable free flap with consistent microvascular anatomy and low donor site morbidity. The modified flap design provided a versatile reconstruction in select patients with small volume defects. These results compare favourably with other published treatment series.