Gracilis muscle flap for reconstruction of extensive soft tissue damage to the palm

Objective: The reconstruction of a large palmar soft tissue defect is a challenge to restore both aesthetics and functionality. Reconstruction with fascio-cutaneous and fascial flaps are the most widely used in the literature, few cases are reported using muscular free flap. We report our experience with the use of the free gracilis muscle flap for palmar soft tissue reconstruction in patients with complex hand traumas. Methods: We review nine cases of complex soft tissue reconstruction to the palm of the hand using the free gracilis muscle flap performed over a period of 20 years. Eight cases involved acute trauma with damage to underlying structures, necessitating multiple surgical procedures. Results: With an average follow-up of 36 months, the free gracilis muscle flap reconstruction enabled patients to achieve good grip, with skin quality resistant to chronic mechanical stress. All patients recovered a protective sensation to deep pressure. The hand's aesthetic appearance was restored in all cases. Flap harvesting altered neither the function nor silhouette of the donor site. Conclusion: The optimal palmar reconstruction technique depends on patient characteristics, associated trauma, and defect size. In our opinion, the gracilis muscle flap technique is both straightforward and effective in restoring mechanical function of the hand, particularly when a large area of the palm has been impacted.