Calotta Nicholas A, Pedreira Rachel, Deune E Gene
From the Departments of Plastic and Reconstructive Surgery.
Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Plast Surg. 2018 Sep;81(3):322-326. doi: 10.1097/SAP.0000000000001523.
Traditionally, the gracilis free flap is used for coverage of small- to medium-sized wounds (<50 cm) or as a functional muscle transfer. The purpose of this study is to examine the use of the gracilis free flap in the reconstruction of large extremity wounds (>100 cm).
We retrospectively reviewed records of 34 patients who underwent extremity soft-tissue reconstruction using gracilis free flaps for wounds larger than 100 cm from 1998 to 2016. The primary outcome was overall flap success rate. Secondary outcomes were rates of major and minor complications. Mean defect size was 145 cm (range, 104-240 cm). Seven flaps covered defects greater than 175 cm. Indications were tumor extirpation (n = 18) and traumatic/posttraumatic wounds (n = 16). The most common time period for flap coverage was immediately (3 days or less) after the defect was created (n = 14). Most flaps were solely muscle (n = 28) and were used for lower extremity or foot coverage (n = 29).
The overall success rate was 94%. Major and minor complications occurred in 5 and 13 cases, respectively. The most common major complication was unplanned reoperation (n = 5), and the most common minor complications were partial skin graft loss (n = 3), partial flap necrosis (n = 3), and planned recipient-site reoperation (n = 5).
Reconstruction of large extremity wounds using the gracilis free flap showed a 94% success rate with few major complications.
传统上，股薄肌游离皮瓣用于覆盖中小面积伤口（<50平方厘米）或作为功能性肌肉转移。本研究的目的是探讨股薄肌游离皮瓣在重建大面积肢体伤口（>100平方厘米）中的应用。
我们回顾性分析了1998年至2016年期间34例使用股薄肌游离皮瓣修复面积大于100平方厘米肢体软组织伤口患者的记录。主要结局指标为皮瓣总体成功率。次要结局指标为严重和轻微并发症的发生率。平均缺损面积为145平方厘米（范围为104 - 240平方厘米）。7例皮瓣覆盖的缺损面积大于175平方厘米。手术指征为肿瘤切除（n = 18）和创伤性/创伤后伤口（n = 16）。皮瓣覆盖的最常见时间段是在缺损形成后立即（3天或更短时间）（n = 14）。大多数皮瓣仅为肌肉瓣（n = 28），用于覆盖下肢或足部（n = 29）。
总体成功率为94%。严重并发症和轻微并发症分别发生在5例和13例患者中。最常见的严重并发症是计划外再次手术（n = 5），最常见的轻微并发症是部分植皮丢失（n = 3）、部分皮瓣坏死（n = 3）和计划中的受区再次手术（n = 5）。
使用股薄肌游离皮瓣重建大面积肢体伤口成功率为94%，严重并发症较少。
