FIG. 18-21. After thorough debridement, a large cavity with exposed bone remained.

FIG. 18-22. The isolated gracilis flap and recipient wound are shown.

FIG. 18-23. The proximal pedicle was anastomosed end-to-side to the anterior tibial vessel.

FIG. 18-24. The entire muscle was skin-grafted.

FIG. 18-25. Follow-up at 18 months shows a healed wound without breakdown: A mirror ulcer has developed on the opposite foot, and was treated in a similar fashion.

CASE 5

The gracilis muscle was again used to close a chronic draining wound over the fourth metatarsal of a diabetic.

FIG. 18-26. Appearance of ulcer.

FIG. 18-27. Gracilis muscle is draped over widely debrided wound, vessels repaired to the anterior tibials.

FIG. 18-28. At 3 years, the patient is ambulatory in normal shoes.

CASE 6

Industrial injury to the lateral anterior compartment of the right leg and foot produced partial loss of the extensor muscles. The gracilis was used as a dynamic transplant and also replaced the unstable scar on the lower third of the leg and lateral malleolar region.

FIG. 18-29. The extent of the unstable scar and muscle defect.

FIG. 18-30. Gracilis muscle transplant in place with proximal anastomoses of the vessels to the anterior tibial vessels and the motor branch of the gracilis to a motor branch of the anterior tibial nerve.

FIG. 18-31. The well-healed gracilis muscle in place, with the foot in neutral position.

FIG. 18-32. Contraction of the gracilis gives increased dorsiflexion of the foot.

CASE 7

A 16-year-old girl suffered a trigeminal and facial nerve injury during removal of a cerebellar tumor.

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