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Free tissue transfer from upper gracilis of medial, posterior thigh safe for breast reconstruction

Free tissue transfer using upper gracilis or profundal artery perforator flaps harvested from the medial or posterior thigh is a safe and reliable option for unilateral autologous breast reconstruction, according to study results published in Plastic and Reconstructive Surgery.

The researchers conducted a retrospective review of patients undergoing double free flap reconstruction for unilateral breast reconstruction using transverse upper gracilis flaps and profundal artery perforator flaps between Sept. 1, 2009, and Jan. 31, 2015.

The study included 21 patients with a total of 42 dual free transfers for unilateral breast reconstruction performed. The upper gracilis flap was used in 19 patients (90%) and the profunda flap in two patients (10%). Average age of patients was 50 years (range, 30-66 years).

Patients were designated as part of one of three groups based on the skin flap inset and the pedicle orientation and anastomosis. The group 1 patients had stacked or clasped hand skin flap inset using the internal mammary system for one flap and the thoracodorsal system the second flap.

The group 2 patients used a horizontal skin flap inset and microvascular anastomosis to the internal mammary system for both flaps without crossed pedicles. The group 3 patients used horizontal inset of both skin flaps and crossed pedicle inset to the internal mammary system.

Perioperative complications occurred in two of four flaps from group 1 (50%), two of two flaps in group 2 (100%), and two of 36 flaps in group 3 (5.5%) (P = .0011). Regarding long-term flap survival, there were three of four flaps survived in group 1 (75%), no surviving flaps in group 2 (0%), and complete survival of 36 flaps in group 3 (100%) (P = .0008).

Patients undergoing unilateral reconstruction with dual transverse upper gracilis flaps were satisfied with the final aesthetic results. The researchers also reported good symmetry outcomes with the contralateral breast and bilateral donor sites.

“When possible, a crossed pedicle anastomosis with a horizontal skin paddle inset produces the easiest reconstructive surgical technique with the least complications,” the researchers wrote. “By using this technique, it is hoped that the learning curve of successful outcomes can be shortened for this operation.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.