Retrospective Review of Free Gracilis Muscle Flaps in the Management of Nonhealing Diabetic Foot Ulceration

This study retrospectively examined data from 45 patients with diabetic foot ulcers who underwent free gracilis muscle reconstruction from January 1999 to December 2003. Twenty-five patients (55.6%) were men and 20 (44.4%) were women. The mean age was 60.2 years (range, 34-90 years). The mean follow-up was 27 months (range, 6-36 months). The lesions were located on the dorsum of the foot (38.5%), hallux (18.5%), and the fifth toe (12.3 %). According to Wagner’s classification, 28% of the ulcers were grade 2, 20% were grade 3, and 51.1% were grade 4. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. A total of 48 gracilis muscle flaps were harvested for reconstruction. There were 35 (72.9 %) patients with complete success when there was complete healing of the flap; 12 patients with partial success when there was some loss of the flap or skin graft, or draining wounds; and 1 patient (2.1%) with failure. There was no infection or hematoma of the flap donor site; only hypertrophic scarring occurred in 3 patients (6.6%). The free gracilis muscle flap is a safe, simple, and effective method for coverage of difficult diabetic foot ulcers. Its use results in good aesthetic and functional outcome and low donor site morbidity.