Free gracilis muscle transfer for coverage of severe foot deformities

The purpose of this study was to describe the gracilis free-tissue transfer for soft-tissue coverage after surgical correction of severe clubfoot and other complex foot deformities in children older than 4 years. Requirements for success include complete correction of deformity, temporary Kirschner-wire fixation to maintain correction, experience in microvascular surgery, and close postoperative monitoring of the tissue transfer. Atrophy of the muscle transfer over the first year precludes the need for debulking procedures. This procedure was used in three children aged 4.5, 7, and 7.3 years with untreated or recurrent equinovarus foot deformities. Postoperatively, these children had flexible, pain-free, plantigrade feet with no donor-site complications. In conclusion, the gracilis free transfer appears to be a safe, effective, and reliable option to cover soft-tissue defects after the treatment of severe clubfeet in older children.