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Free gracilis transfer is a procedure used for a number of different reconstructive issues. The gracilis free flap is considered one of the reconstructive “workhorse” flaps and can be taken with or without nerve for functional reconstruction, or a skin paddle. This activity reviews the relevant anatomy, equipment used, and highlights the role of the inter-professional team in evaluating and treating patients who undergo this procedure. Objectives: Describe the relevant anatomy of the free gracilis harvest. Identify the most common physical exam associated with flap failure. Recall, analyze, and select appropriate evaluation of the potential complications and clinical significance of free gracilis transfer. Explain the importance of collaboration and communication amongst the inter-professional team to ensure the appropriate selection of candidates for free gracilis transfer and to enhance post-operative management. Access free multiple choice questions on this topic.

The first “flaps” of record date back to 600 BC when Sushruta Samita utilized local-regional flaps for nasal reconstruction. While a graft lives off of the nutrients from a wound bed, a flap is harvested with its own blood supply. Orticochea first described the gracilis flap as a pedicled myocutaneous flap in 1972.[1] His work was expanded upon, and in 1972 Harri published a series of free gracilis flaps for various soft tissue injuries.[2][3] Since then, the gracilis muscle flap has become one of the “workhorse” flaps for reconstructive surgeons. Because of its reliable pedicle, versatile nature, and low donor site morbidity, the gracilis flap can be utilized for an array of soft tissue defects.

As with any surgery, free tissue transfer is not without complications. These complications may be minor such as skin necrosis or partial flap loss to major such as flap failure. One study of extremity trauma and reconstruction with free gracilis muscle only transfer showed higher generalized complications with increasing age >70 and ASA score. Higher ASA score also correlated with increased major flap complications.[10]

In a busy reconstructive practice, the plastic surgeon is involved with a vast number of different specialties and subspecialties to heal wounds and provide solutions to complicated problems. These include head and neck reconstruction, limb salvage, breast reconstruction, and traumatic soft tissue defects. These patients frequently are topics of discussion during interdisciplinary rounds. This interprofessional approach to manage complex injuries or wounds provides the patient with the optimal outcome.