10-Year experience with the gracilis myofasciocutaneous flap

In summary, we continue to include perigracilis fascia to enhance the circulation of the gracilis myofasciocutaneous flap. Our series of 37 flaps in more than 10 years has resulted in only two marginal skin necroses. We are now more cautious, however, to avoid pressure and traction forces when the flap is placed in a dependent and external position, such as near the ischial prominence. In these cases, we use a Fluidair bed in the immediate postoperative period. We are also careful to align the flap in relation to the critical perforators and restrict electrocautery in these areas to maintain flap perfusion.