The Gracilis Muscle Flap: A “Work Horse” Free Flap in Diabetic Foot Reconstruction

Diabetes is a leading cause of foot ulcers and lower limb amputation throughout the world. Adequate wound debridement and cover is the standard of care, but lack of adequate vascularised local tissue poses a major challenge. The gracilis flap offers various advantages in this respect, which we would like to discuss in this study, and hence makes it an attractive option in diabetic foot patients.

This retrospective study was conducted over a period of 2 years, from 2018 to 2020 in the Department of Plastic Surgery, Kauvery Hospital, Trichy, India. The flap harvest time, total operation time, flap take and complications associated with the procedure were noted.

Overall, 56 patients were enrolled. The average flap harvest time was 55 +/- 10 min and the average overall operation time was 240+/- 30 minutes. There was complete flap survival in 42 (75%) patients, a partial survival in 12 (21.42%) patients and complete flap loss in 2 (3.57%) patients. In the donor site complications hypertrophic scarring was reported in 5 (8.92%) and donor site seroma in 3(5.3%) patients.

The free gracilis flap offers good wound healing and excellent foot contour besides being safe and effective in small to medium sized defects makes it an excellent free flap in diabetic foot reconstruction.