Complex perineal and groin wound reconstruction using the extended dissection technique of the gracilis flap

Background: The purpose of this article is to review the applicaitons of the extended-dissection technique of the gracilis flap in a high-risk patient population with complex wounds requiring more coverage than a standard gracilis flap may provide. To our knowledge, this is the first study applying the extended dissection dissection technique as described by Hasen et al. to pedicled gracilis flaps. Methods: A chart review conducted from 2003 to 2006 identified 19 consecutive patients as having undergone an extended gracilis dissection. Once the pedicle is identified on the medial border of the gracilis, dissection continues proximally, dividing the rich vascular network of perforators to the adductor muscles. The gracilis is then passed beneath the adductor longus and delivered adjacent to the sartorius, where dissection proceeds directly down to the profunda femoris. Results: All reconstructions were successful. There was one complication presenting as a late infection at the donor site. Mean patient age was 66 years and nearly all patients had multiple significant comorbidities, including diabetes, peripheral vascular disease, and/or radiation therapy. Conclusions: The extended-dissection technique for gracilis harvest has significant benefits for use in pedicled flaps, including a greater arc of rotation and no restriction on postoperative ambulation or thigh abduction. These factors are particularly important in the challenging patient population represented in this study and add to the reliability and versatility of the gracilis flap. Anatomical illustrations for technical guidance in this procedure are also provided.