8. Gordon, L. Buncke, H.J., and Alpert, B.S.: Free latissimus dorsi muscle flap with split-thickness skin graft cover: A report of 16 cases. Plast. Reconstr. Surg. 70:173, 1982.

9. Hagan, K., Buncke, H.J., and Gonzalez, R.: Free latissimus dorsi muscle flap coverage of an electrical burn of the lower extremity. Plast. Reconstr. Surg. 69:125, 1982.

Gracilis Muscle Transplantation

Transplantation of the gracilis muscle was first performed clinically in 1978 by Harii and his associates, who used the reinnervated free muscle to restore motion after facial paralysis.1 Subsequent reports have supported the use of the gracilis as a free transfer, particularly for long linear defects and as a functional transplant.2-3

INDICATIONS

The gracilis muscle is long and thin, with neurovascular anatomy that makes it ideally suited for transplantation. One of its most useful applications is in the coverage of defects measuring as large as 6 cm wide and 20 cm long. The most common application has been in wounds over the distal third of the lower extremity in which bone and other underlying structures have been exposed. Chronic osteomyelitis with multiple sinus tracts through unstable skin coverage may be treated with gracilis transplantation.4-5 Preoperative management includes multiple debridements, sequestrectomy, and systemic antibiotics, as indicated. Preoperative angiography is performed to determine the arterial vascular status.

Smaller pieces of gracilis muscle may be taken to cover lesser defects such as on the ankle or foot, or in the upper extremity, such as over the elbow. Smaller defects with exposed vital structures elsewhere in the body, such as on the head and neck, may also be suited for gracilis muscle transplantation. The primary advantage of the use of the gracilis muscle for coverage is related to the ability to transplant a well vascularized piece of muscle easily to areas where excessive bulk would significantly detract from the final result.

The gracilis muscle has proved invaluable in the coverage of exposed metal plates or other hardware in open fractures of the distal lower extremities. It has been used extensively to replace areas of unstable coverage, such as split-thickness skin grafts in areas subject to repetitive trauma, especially in the pretibial region. In patients having fractures with external fixators in place, the entire gracilis muscle transplantation can be performed without removing the external fixation. If a Hoffman device is in place, one side is simply removed and the procedure is done with the other hardware in place. The removed portion is replaced at the end of the procedure.

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