The Gracilis Myocutaneous Free Flap in Autologous Breast Reconstruction
Sven N. Sandeen, M.D., Luis Ortiz, Stephen J. Vega, M.D..
University of Rochester, Rochester, NY, USA.
Background: The gracilis myocutanous free flap provides an alternative for autologous breast reconstruction. It avoids abdominal donor site morbidity, allows for a quicker recovery, provides an alternative to the thin patient with minimal abdominal donor tissue, provides a hidden and acceptable donor site and allows for supine positioning for harvest and inset in a timely fashion.
Methods: A retrospective review was conducted for all autologous post-mastectomy reconstructions performed between January 2005 and March 2008. All patients receiving gracilis myocutaneous free flap reconstruction for post-mastectomy defects were included in this study. Office and hospital charts were reviewed for age, BMI, PMH, PSH, ASA class, tobacco use, radiation therapy, chemotherapy, clinical stage at mastectomy, timing and side of reconstruction, anastamotic configuration, complications, surgical revisions, length of stay, and length of follow-up.
Results: Twenty-three gracilis flaps were performed in 18 patients during the study period. Bilateral flaps were performed in five patients and unilateral flaps in 13 patients. Average patient age was 50.4 years, average BMI 25.6, average ASA class 1.83, 1.8% had hypertension, 17.7% were smokers, none were diabetic, 11.8% were obese, and 5.6% had CVD. Outcomes included 100% flap survival, average operating time of 4.9 hours for unilateral and 6.7 hours for bilateral flaps, thoracodorsal artery used in 27% and internal mammary artery used in 73% as the recipient vessel, average hospital stay of 3.75 days, major complication rate of 5.9% and average length of follow up of 7 months.
Conclusions: The gracilis myocutaneous free flap provides an alternative breast reconstruction for today’s breast cancer patient. It allows for harvest and inset in the supine position, creation of a moderate breast volume, consistent anatomy and acceptable donor site morbidity with good contour.