Gracilis and Rectus Abdominis Flaps for Leg and Foot Reconstruction

Distal third wounds of the lower extremity are challenging to reconstruct because vital structures are frequently exposed and local options are often limited. Free tissue transfer is regarded as the reconstructive gold standard for defects of the distal leg, ankle, and foot. The gracilis and rectus abdominis muscle flaps have proved reliable for free flap reconstruction of the distal lower extremity. This chapter provides a general approach to lower extremity reconstruction and highlights the role of the gracilis and rectus abdominis muscles and musculocutaneous flaps in the reconstruction of the distal lower extremity. Each flap is reviewed with special attention given to its indications, contraindications, anatomy, preoperative preparation, room setup, flap design, and harvest, as well as to donor site management. Considerations for flap inset and anastomosis as well as postoperative care are also discussed. Four case examples are also provided.