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RACS ASC 2024

The Gracilette – a case series of muscle-sparing Gracilis flap reconstruction to reduce donor site morbidity

Poster

Presentation Description

Institution: Princess Alexandra Hospital - Queensland, Australia

Introduction: The gracilis muscle is considered a workhorse in reconstructive surgery. The dominant pedicle is based on the terminal branch of the medial femoral circumflex artery, with classically two ‘minor’ upper and distal pedicles. With the aim of reducing free flap surgery morbidity, the authors describe the muscle-sparing ‘gracilette’ gracilis free flap as a novel surgical technique based on the gracilis' minor pedicle. Methods: The authors performed a retrospective review of adult patients requiring small-volume soft tissue reconstruction at the Princess Alexandra Hospital who underwent the muscle-sparing gracilis free flap technique. A historical comparison was made using previously reported treatment outcomes, with the primary outcome focused on non-union, osteomyelitis, or osteoradionecrosis. Secondary outcomes included post-operative lengths of stay, donor site complications, return to theatre, and flap compromise or loss. Results: Between 2019-2023, eleven patients underwent a ‘gracilette’ free flap reconstruction. There were no major soft tissue or acute microvascular complications, including flap loss. There were two head and neck and seven lower limb reconstructions. The median ischemic time, length of stay, and follow-up were 64 minutes, nine days, and 34 months, respectively. Smoking was significantly associated with ‘poor outcomes’ in both univariate (p = 0.05) and multivariate (p = 0.014) analyses. Conclusion: From the authors' experience, the muscle-sparing ‘gracilette’ gracilis reconstruction is a safe and reliable technique with predictable vascular anatomy and low donor site morbidity. With further evidence, the ‘gracilette’ has the potential to be added to the reconstructive surgeon's armamentarium for small-volume soft tissue reconstruction.

Speakers

Authors

Authors

Dr Oliver Hovav - , Dr Tavis Read - , Dr George Castrisos - , Dr Jay Wiper -