[The free gracilis muscle flap in the foot and ankle reconstructive surgery]

Subject: The distal third of the leg, ankle and foot is an anatomical region where reconstructive surgery is difficult and many flaps are described. The authors describe their own experience in the reconstruction of this anatomical region using the gracilis muscle free flap.

Methods: From January 2009 to April 2012, the authors operated 32 patients for reconstructive surgery of the distal third of the leg, ankle or foot using a free gracilis muscle flap. A retrospective analysis of the etiology and the size of the loss of tissue substance were performed. The operative data, complications, as well as aesthetic and functional results were analyzed.

Results: Thirty-two free gracilis muscle flap were performed. The authors reported five necrosis requiring surgical use of a locoregional flap. The mean duration of follow-up was 15.2 months (6-34 months). The average size of the defect was 53.4 cm(2) (35.7 to 78.1cm(2)) and the etiology was traumatic in 81.3% of cases. The Vancouver score of the area reconstructed was excellent. Functional assessment of the ankle was satisfactory and usual footwear was possible in 96% of patients. Concerning the isokinetic study of the ankle, maximum and average forces were similar to the healthy ankle in a tumor etiology, but less when traumatic.

Conclusion: In our experience, the free gracilis muscle flap is an excellent technique for the reconstruction of tissue defects of the distal third of the leg, ankle or foot. Its donor site morbidity is very low. The free gracilis flap is suitable for small or long lost of substance and its adaptation at the receptor site is excellent. For these reasons, the gracilis muscle free flap should have its place in reconstructive surgery of the foot and ankle.