gms | German Medical Science

49. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 23. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

13.09. - 15.09.2018, Bochum

Plantar reconstruction: free gracilis muscle flaps versus free fasciocutaneous anterolateral thigh flaps – long term outcomes

Meeting Abstract

  • presenting/speaker Paul Heidekrüger - Universitätsklinikum Regensburg
  • Lukas Prantl - Caritas-Krankenhaus St. Josef
  • Milomir Ninkovic - Klinikum Bogenhausen
  • Aung Thiha - Universitätsklinikum Regensburg
  • Denis Ehrl - LMU Klinikum der Universität München
  • P. Niclas Broer - Klinikum Bogenhausen

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 49. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 23. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Bochum, 13.-15.09.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc213

doi: 10.3205/18dgpraec213, urn:nbn:de:0183-18dgpraec2130

Published: September 20, 2018

© 2018 Heidekrüger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background: In plantar reconstruction, the weight-bearing areas present unique surgical challenges. In these cases of larger defects, microvascular flap reconstruction becomes the next option. Several free flap modalities have been described in this respect, but there is still a dissent regarding the best option. Aim of this study is to compare free split-skin grafted muscle (gracilis) and non-neurotized fasciocutaneous (anterolateral thigh) flaps for plantar reconstruction with respect to long-term functional outcomes including sensory recovery.

Methods: Over a 7-year period (2011 – 2017), a total of 89 patients received 100 free flaps (ALT n=46; gracilis n=54) for plantar reconstruction at our institution. The data were screened for patients" demographics, intra- and perioperative details. Postoperative complications were accounted for and the two groups compared accordingly.

Results: Overall, there were no significant differences between the two groups of patients regarding the rate of major- and minor surgical. However, the group of ALT flaps showed a significantly higher rate regarding the need for secondary surgeries (39.13 (ALT) versus 18.52% (gracilis); p=0.022).

A total of 68 patients returned for long-term evaluation and showed good results. The numeric rating scale evaluating pain was low in both groups, while the assessment of the scarring utilizing the Vancouver scar scale (VSS) showed good outcomes, but revealed significantly better results in the ALT group.

Conclusion: Both the free ALT- and gracilis flaps are well suited for plantar reconstruction yielding similar functional outcomes, while the ALT flap produces less scarring and thus presents our preferred option.