Reconstruction of complex wound in calf with two types of free gracilis musculocutaneous flap
10.3760/cma.j.cn441206-20231114-00076
- VernacularTitle:两种类型游离股薄肌肌皮瓣修复小腿复杂创面
- Author:
Erlin CHENG
1
;
Peng REN
;
Abula ABULAITI
;
Abulaiti ALIMUJIANG
;
Maimaiti XIAYIMAIERDAN
;
Wumaierjiang YILIYAER
;
Kai LIU
;
Yusufu AIHEMAITIJIANG
Author Information
1. 新疆医科大学第一附属医院骨科中心显微修复外科，乌鲁木齐 830054
- Keywords:
Gracilis musculocutaneous flap;
Calf;
Complex wound;
Repair;
Microsurgical technique
- From:
Chinese Journal of Microsurgery
2024;47(3):254-260
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of two types of free gracilis musculocutaneous flap in transverse or vertical for reconstruction of the complex wound in calf.Methods:A retrospective series case study was conducted to analyse the clinical data of 22 patients who were treated in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University for complex single wounds in calf from August 2019 to January 2023. The patients were 12 males and 10 females and aged 26-58 years old, with 46.7 years old in average. There were 12 wounds on the left calf and 10 on the right. Nine of the wounds were of car accident, 8 of iatrogenic complications, 3 of bone infection and 2 of tumour resection. The wounds sized at 10.0 cm× 5.0 cm - 15.0 cm×7.0 cm. Sixteen transverse gracilis myocutaneous flaps and 6 vertical gracilis myocutaneous flaps were designed and harvested to reconstruct complex wounds in calf. The flaps were 12.0 cm×6.0 cm - 22.0 cm×9.0 cm in size. Time for the gracilis myocutaneous flap harvesting and the time for whole surgery were recorded. The time for flap harvest was 40-60 minutes and the time for the whole surgery was 3- 5 hours. Flap donor sites were directly sutured. All patients were included in the regular postoperative follow-up at outpatient clinic or through telephone and WeChat interviews and the flap survival, long-term flap appearance, healing of donor and recipient sites and limb functions were observed.Results:All 22 flaps survived after surgery. One flap had a blue edge with blood oozing. Urgent surgical exploration revealed that embolization occurred at the anastomotic site between the great saphenous vein at the proximal end of the flap and the great saphenous vein at the recipient site. After removal of the thrombus, the veins were re-anastomosed and flap survived. All the donor sites healed in stage one and functioned well. All patients entered postoperative follow-up for 5-25 months, 14.42 months in average. The flaps were in satisfactory appearance with good texture. All recipient sites healed without complication. The infected wounds were controlled. Function of the limbs was evaluated according to the Punor functional assessment criteria with excellent for 15 patients, good for 5 and fair for 2.Conclusion:Application of free transverse and vertical layout of gracilis musculocutaneous flap is an effective method to reconstruct a complex wound in calf. The anastomosis of the great saphenous vein at the proximal end of the gracilis muscle flap with great saphenous vein or small saphenous vein at the recipient site can reduce the occurrence of venous occlusion.
