A 20-year tertiary cancer center’s experience utilizing the pedicled gracilis myocutaneous flap

Background The gracilis myocutaneous flap is a versatile reconstructive option. Despite wide applicability, concerns are often raised regarding the unreliable vascular perfusion of the distal third of the flap’s skin paddle. This study presents our experience utilizing the pedicled gracilis myocutaneous flap for various oncologic defects to highlight the versatility, safety, and utility of this flap. Methods A retrospective analysis was performed for patients who underwent reconstruction utilizing a gracilis myocutaneous flap over the course of 20 years (January 1998–June 2018). Postoperative outcomes were reviewed to determine the incidence of infection, dehiscence, seroma, or hematoma for both donor and recipient sites. Incidence of flap skin or muscle loss was also recorded. Results A total of 37 patients met our inclusion criteria, and data from 41 vertically oriented gracilis myocutaneous flaps was analyzed. A majority of our patients had a previously irradiated wound bed (73%). The overall donor site complication rate was 19.5%. The recipient site complication rate was 41.5% and included partial flap loss (14.6%). Partial flap loss included distal flap skin necrosis incidence (9.7%). Conclusion When taking into account the size of the primary defect prompting reconstruction and prior recipient bed irradiation history, our cohort shows reasonable complication rates. Distal tip skin necrosis rate was also low, which suggests that the distal third’s vascular supply should not be a limiting factor. Level of evidence Level IV, therapeutic study.