GRACILIS MYOCUTANEOUS FLAP: EVALUATION OF POTENTIAL RISK FACTORS AND LONG-TERM DONOR-SITE MORBIDITY OTHON PAPADOPOULOS, M.D., Ph.D., 1,2 PETROS KONOFAOS, M.D., 1,3 * PANOS GEORGIOU, M.D., 2 CHRISOSTOMOS CHRISOSTOMIDIS, M.D., 2 ZACHARIAS TSANTOULAS, M.D., 2 DIMITRIOS KARYPIDIS, M.D., 2 and ALKIVIADIS KOSTAKIS, M.D. 1 This study reviewed our experience with the gracilis myocutaneous (GMC) flap, potential risk factors for flap necrosis, and long-term mor- bidity at the donor-site. From 1993 to 2002, 29 GMC flaps were harvested from 27 patients (pedicled n 5 21 and free n 5 8). The overall incidence of flap necrosis was 13.79% (partial (n 5 2) and total (n 5 2) necrosis). Flap necrosis was correlated with body mass index >25 (P 5 0.022), with smoking (P 5 0.04 9) and with radiation therapy at the recipient site (P 5 0.020). The long-term morbidity at the donor- site was low, except for scar appearance (17.24%), thigh contour deformity (58.62%), and hypoesthesia (17.24%). Significant age and gen- der differences were seen for ranking of scar ugliness, with females (P 5 0.0061) and younger patients (age 55) (P 5 0.046) assigned higher values. Significant age differences were seen for ranking of thigh contour deformity, with younger patients assigned higher values (P 5 0.0012). In conclusion, patient overweight, smoking, and previous radiation therapy at the recipient site may be the ‘potential risk fac- tors’ for flap necrosis. The long-term morbidity at the donor-site was low, which was in agreement with previous reported studies. A larger series would be the subject of a future study. V V C 2011 Wiley-Liss, Inc. Microsurgery 31:448–453, 2011. The gracilis muscle has widely been used in reconstruc- tive surgery since its first description by Orticochea in the early 1970s, 1 although its use in anal sphincter recon- struction was described much earlier. 2 Nowadays, gracilis myocutaneous (GMC) flap is used either as a pedicled 3,4 or as a free flap 5–7 due to its reliable neurovascular pedi- cle and its unbulky shape. Despite the previous bad GMC flap reputation due to the observed unreliability of its skin component, 8 recent approaches with retention of the surrounding deep fascia have been more successful. 9 McCraw et al. 10 and Nakajima et al. 11 were the first to study the vascular anatomy of the skin paddle of the GMC flap in detail. Many studies have also focused on the vascular anatomy of the gracilis muscle, emphasizing the anatomy of the proximal dominant pedicle 12 and its distribution. 13 Yousif et al. 13 introduced a new flap design with a transverse orientation of the cutaneous pad- dle in the proximal third of the gracilis muscle. Hasen 14 proposed an extended approach to the vascular pedicle of the gracilis muscle flap without lengthening the scar or the need for specialized lighting or additional retractors. The low rate of donor-site morbidity is often cited among the advantages of the GMC flap, 15 but only the immediate postoperative complications at the donor-site have extensively been reported. To the best of our knowl- edge, there are only two reports in literature 16,17 for the long-term morbidity of the donor-site following the eleva- tion of the GMC flap. The purpose of this retrospective study was to report our experience with the GMC flap. Furthermore, the effect of potential risk factors for flap necrosis and the long-term morbidity of the donor-site following harvest- ing of the GMC flap were analyzed. PATIENTS AND METHODS Patients’ Demographics From 1993 to 2002, 27 patients underwent reconstruc- tion with a GMC flap at the Second Department of Pro- pedeutic Surgery of Athens University and at the Depart- ment of Plastic Surgery of A. Sygros Hospital. In all cases, the reconstructive procedure was undertaken by the senior author (O.P.). Eligibility criteria included: 1) age 18 years old; 2) reconstruction with either a free or a pedicled GMC flap; 3) follow-up 2 years; 4) patients included answered the questionnaire related to the long-term donor-site morbid- ity. The data collected included: patients’ age, gender, body mass index (BMI), and smoking status, the cause, the location, and the size of the defect, any previous sur- gical interventions, and the range of follow-up. Patients’ demographic characteristics are summarized in Table 1. Preoperative Evaluation It was consisted of a detailed history, physical exami- nation, and imaging studies. When a free GMC flap was scheduled, an arteriogram of the vessels of the recipient site was performed in all cases to prevent potential com- plication in patients with congenital vascular anomalies of the vessels of the recipient sites (e.g., leg). In patients with large skin tumors, preoperative management included biopsy of the tumor and staging studies. 1 Second Department of Propedeutic Surgery, LAIKO Hospital, Athens, Greece 2 Department of Plastic and Reconstructive Surgery, A SYGROS Hospital, Athens, Greece 3 Department of Plastic Surgery and Burns, KAT Hospital, Athens, Greece *Correspondence to: Petros Konofaos, M.D., 36, Megistis Street – Athens 11364, Greece. E-mail: petroskonofaosmd@aol.com Received 28 September 2010; Revision accepted 4 February 2011; Accepted 11 February 2011 Published online 24 August 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/micr.20899 V V C 2011 Wiley-Liss, Inc.