{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:12:40Z","timestamp":1785899560178,"version":"3.56.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Bern"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Purpose: Gracilis muscle flaps are useful to cover defects of the hand. However, there are currently no studies describing outcome measurements after covering soft tissue defects using free flaps in the hand. Aim: To analyze mid-term results of gracilis muscle flap coverage for defects on the hand, with regard to functional and esthetic integrity. Methods: 16 patients aged 44.3 (range 20\u201370) years were re-examined after a mean follow-up of 23.6 (range 2\u201377) months. Mean defect size was 124 (range 52\u2013300) cm<jats:sup>2<\/jats:sup> located palmar (<jats:italic>n<\/jats:italic>\u2009=\u20099), dorsal (<jats:italic>n<\/jats:italic>\u2009=\u20096), or radial (<jats:italic>n<\/jats:italic>\u2009=\u20091). All flaps were performed as microvascular muscle flaps, covered by split thickness skin graft. Results: Flaps survived in 15 patients. 6 patients required reoperations. Reasons for revisions were venous anastomosis failure with total flap loss (<jats:italic>n<\/jats:italic>\u2009=\u20091) requiring a second gracilis muscle flap; necrosis at the tip of the flap (<jats:italic>n<\/jats:italic>\u2009=\u20091) with renewed split thickness skin cover. A surplus of the flap (<jats:italic>n<\/jats:italic>\u2009=\u20092) required flap thinning and scar corrections were performed in 2 patients. Mean grip strength was 25% (range 33.3\u201396.4%) compared to the contralateral side and mean patient-reported satisfaction 1.4 (range 1\u20133) (1\u2009=\u2009excellent; 4\u2009=\u2009poor). Conclusions: Gracilis muscle flaps showed a survival rate of 94%. Patients showed good clinical outcomes with acceptable wrist movements and grip strength as well as high reported satisfaction rates. Compared to fasciocutaneous free flaps, pliability and thinness especially on the palmar aspect of the hand are advantageous. Hence, covering large defects of the hand with a gracilis muscle flap can be a very satisfactory procedure.<\/jats:p><jats:p>Level of evidence: IV observational.<\/jats:p>","DOI":"10.1007\/s00402-024-05207-7","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T17:02:32Z","timestamp":1706115752000},"page":"1865-1873","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mid-term Clinical Outcome of Microvascular Gracilis Muscle Flaps for Defects of the Hand"],"prefix":"10.1007","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3440-5615","authenticated-orcid":false,"given":"Tatjana","family":"Pastor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel","family":"Meier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Merky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luzian","family":"Haug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Pastor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Zubler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"V\u00f6gelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"5207_CR1","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/j.hcl.2017.04.001","volume":"33","author":"S Ono","year":"2017","unstructured":"Ono S, Sebastin SJ, Ohi H, Chung KC (2017) Microsurgical flaps in repair and reconstruction of the hand. Hand Clin 33:425\u2013441. https:\/\/doi.org\/10.1016\/j.hcl.2017.04.001","journal-title":"Hand Clin"},{"key":"5207_CR2","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/00006534-197603000-00003","volume":"57","author":"K Harii","year":"1976","unstructured":"Harii K, Ohmori K, Sekiguchi J (1976) The free musculocutaneous flap. Plast Reconstr Surg 57:294\u2013303. https:\/\/doi.org\/10.1097\/00006534-197603000-00003","journal-title":"Plast Reconstr Surg"},{"key":"5207_CR3","doi-asserted-by":"publisher","first-page":"204","DOI":"10.3109\/2000656X.2011.624697","volume":"46","author":"B Del Frari","year":"2012","unstructured":"Del Frari B, Schoeller T, Wechselberger G (2012) Free gracilis muscle flap for treatment of a large temporoparietal defect. J Plast Surg Hand Surg 46:204\u2013206. https:\/\/doi.org\/10.3109\/2000656X.2011.624697","journal-title":"J Plast Surg Hand Surg"},{"key":"5207_CR4","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1097\/PRS.0b013e31824422da","volume":"129","author":"GM Huemer","year":"2012","unstructured":"Huemer GM, Larcher L, Schoeller T, Bauer T (2012) The free gracilis muscle flap in achilles tendon coverage and reconstruction. Plast Reconstr Surg 129:910\u2013919. https:\/\/doi.org\/10.1097\/PRS.0b013e31824422da","journal-title":"Plast Reconstr Surg"},{"key":"5207_CR5","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1002\/micr.20050","volume":"24","author":"GM Huemer","year":"2004","unstructured":"Huemer GM, Dunst KM, Maurer H, Ninkovic M (2004) Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations. Microsurgery 24:369\u2013373. https:\/\/doi.org\/10.1002\/micr.20050","journal-title":"Microsurgery"},{"key":"5207_CR6","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1002\/micr.20105","volume":"25","author":"GM Huemer","year":"2005","unstructured":"Huemer GM, Bauer T, Wechselberger G, Schoeller T (2005) Gracilis muscle flap for aesthetic reconstruction in the head and neck region. Microsurgery 25:196\u2013202. https:\/\/doi.org\/10.1002\/micr.20105","journal-title":"Microsurgery"},{"key":"5207_CR7","doi-asserted-by":"crossref","unstructured":"Krimmer H, Hahn P, Lanz U (1995) Free gracilis muscle transplantation for hand reconstruction. Clin Orthop 13\u201318","DOI":"10.1097\/00003086-199505000-00004"},{"key":"5207_CR8","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s001320050254","volume":"27","author":"H Krimmer","year":"1998","unstructured":"Krimmer H, van Schoonhoven J, Lanz U (1998) Transplantation of the M. gracilis in the reconstruction of hand function. Orthopade 27:445\u2013450. https:\/\/doi.org\/10.1007\/s001320050254","journal-title":"Orthopade"},{"key":"5207_CR9","first-page":"287","volume":"81","author":"M Innocenti","year":"1996","unstructured":"Innocenti M, Ceruso M, Angeloni R et al (1996) Reinnervated free gracilis muscle transplantation in the treatment of Volkmann\u2019s syndrome of the forearm. Chir Organi Mov 81:287\u2013293","journal-title":"Chir Organi Mov"},{"key":"5207_CR10","first-page":"803","volume":"45","author":"EP Egerszegi","year":"1991","unstructured":"Egerszegi EP, Zuker RM, Caouette-Laberge L et al (1991) Neurovascular transfer of the m. gracilis for the treatment of Volkmann\u2019s contracture following supracondylar fracture in childhood. Ann Chir 45:803\u2013810","journal-title":"Ann Chir"},{"key":"5207_CR11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/s0753-9053(86)80053-9","volume":"5","author":"A Kapandji","year":"1986","unstructured":"Kapandji A (1986) Clinical test of apposition and counter-apposition of the thumb. Ann Chir Main Organe Off Soc Chir Main 5:67\u201373. https:\/\/doi.org\/10.1016\/s0753-9053(86)80053-9","journal-title":"Ann Chir Main Organe Off Soc Chir Main"},{"key":"5207_CR12","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1001\/jama.262.7.925","volume":"262","author":"AR Tarlov","year":"1989","unstructured":"Tarlov AR, Ware JE, Greenfield S et al (1989) The medical outcomes study. an application of methods for monitoring the results of medical care. JAMA 262:925\u2013930. https:\/\/doi.org\/10.1001\/jama.262.7.925","journal-title":"JAMA"},{"key":"5207_CR13","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/BF00562315","volume":"8","author":"CR Joyce","year":"1975","unstructured":"Joyce CR, Zutshi DW, Hrubes V, Mason RM (1975) Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 8:415\u2013420. https:\/\/doi.org\/10.1007\/BF00562315","journal-title":"Eur J Clin Pharmacol"},{"key":"5207_CR14","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-022-02193-6","author":"T Pastor","year":"2022","unstructured":"Pastor T, Hermann P, Haug L et al (2022) Semi-occlusive dressing therapy versus surgical treatment in fingertip amputation injuries: a clinical study. Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc. https:\/\/doi.org\/10.1007\/s00068-022-02193-6","journal-title":"Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc"},{"key":"5207_CR15","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1002\/micr.20951","volume":"32","author":"TO Engelhardt","year":"2012","unstructured":"Engelhardt TO, Rieger UM, Schwabegger AH, Pierer G (2012) Functional resurfacing of the palm: flap selection based on defect analysis. Microsurgery 32:158\u2013166. https:\/\/doi.org\/10.1002\/micr.20951","journal-title":"Microsurgery"},{"key":"5207_CR16","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00130911-200012000-00008","volume":"4","author":"G Germann","year":"2000","unstructured":"Germann G, Bruener S (2000) Free flap coverage of palmar hand wounds. Tech Hand Up Extrem Surg 4:272\u2013281. https:\/\/doi.org\/10.1097\/00130911-200012000-00008","journal-title":"Tech Hand Up Extrem Surg"},{"key":"5207_CR17","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1054\/jhsb.2001.0708","volume":"27","author":"DJ Mowatt","year":"2002","unstructured":"Mowatt DJ, Shah M, Watson JS (2002) Palmar resurfacing techniques: an \u201cideal\u201d opportunity and the importance of long-term follow-up. J Hand Surg Edinb Scotl 27:198\u2013201. https:\/\/doi.org\/10.1054\/jhsb.2001.0708","journal-title":"J Hand Surg Edinb Scotl"},{"key":"5207_CR18","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.bjps.2022.10.056","volume":"77","author":"C Zubler","year":"2022","unstructured":"Zubler C, Lese I, Pastor T et al (2022) The osteocutaneous SCIP flap: a detailed description of the surgical technique and retrospective cohort study of consecutive cases in a tertiary European centre. J Plast Reconstr Aesthetic Surg JPRAS 77:21\u201330. https:\/\/doi.org\/10.1016\/j.bjps.2022.10.056","journal-title":"J Plast Reconstr Aesthetic Surg JPRAS"},{"key":"5207_CR19","doi-asserted-by":"publisher","unstructured":"Adani R, Tarallo L, Marcoccio I, et al (2005) Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 116:467\u2013473; discussion 474\u2013477. https:\/\/doi.org\/10.1097\/01.prs.0000173059.73982.50","DOI":"10.1097\/01.prs.0000173059.73982.50"},{"key":"5207_CR20","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.bjps.2020.08.110","volume":"74","author":"N Seyidova","year":"2021","unstructured":"Seyidova N, Anderson K, Abood A (2021) Comparison of patients satisfaction with aesthetic outcomes following lower extremity reconstruction: Muscle vs. fasciocutaneous free flaps. J Plast Reconstr Aesthetic Surg JPRAS 74:65\u201370. https:\/\/doi.org\/10.1016\/j.bjps.2020.08.110","journal-title":"J Plast Reconstr Aesthetic Surg JPRAS"},{"key":"5207_CR21","doi-asserted-by":"publisher","unstructured":"Chen HC, el-Gammal TA (1997) The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg 99:454\u2013459. https:\/\/doi.org\/10.1097\/00006534-199702000-00021","DOI":"10.1097\/00006534-199702000-00021"},{"key":"5207_CR22","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/s0363-5023(87)80045-x","volume":"12","author":"LR Scheker","year":"1987","unstructured":"Scheker LR, Kleinert HE, Hanel DP (1987) Lateral arm composite tissue transfer to ipsilateral hand defects. J Hand Surg 12:665\u2013672. https:\/\/doi.org\/10.1016\/s0363-5023(87)80045-x","journal-title":"J Hand Surg"},{"key":"5207_CR23","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/01.sap.0000232832.18894.2b","volume":"58","author":"BG Ulusal","year":"2007","unstructured":"Ulusal BG, Lin Y-T, Ulusal AE, Lin C-H (2007) Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: a retrospective analysis of 118 cases. Ann Plast Surg 58:173\u2013178. https:\/\/doi.org\/10.1097\/01.sap.0000232832.18894.2b","journal-title":"Ann Plast Surg"},{"key":"5207_CR24","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0266-7681(92)90086-h","volume":"17","author":"B Graham","year":"1992","unstructured":"Graham B, Adkins P, Scheker LR (1992) Complications and morbidity of the donor and recipient sites in 123 lateral arm flaps. J Hand Surg Edinb Scotl 17:189\u2013192. https:\/\/doi.org\/10.1016\/0266-7681(92)90086-h","journal-title":"J Hand Surg Edinb Scotl"},{"key":"5207_CR25","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.jhsa.2011.04.016","volume":"36","author":"JP Higgins","year":"2011","unstructured":"Higgins JP (2011) A reassessment of the role of the radial forearm flap in upper extremity reconstruction. J Hand Surg 36:1237\u20131240. https:\/\/doi.org\/10.1016\/j.jhsa.2011.04.016","journal-title":"J Hand Surg"},{"key":"5207_CR26","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1097\/01.prs.0000299924.69019.57","volume":"121","author":"NF Jones","year":"2008","unstructured":"Jones NF, Jarrahy R, Kaufman MR (2008) Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand. Plast Reconstr Surg 121:887\u2013898. https:\/\/doi.org\/10.1097\/01.prs.0000299924.69019.57","journal-title":"Plast Reconstr Surg"},{"key":"5207_CR27","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/00006534-199308000-00014","volume":"92","author":"C Angrigiani","year":"1993","unstructured":"Angrigiani C, Grilli D, Dominikow D, Zancolli EA (1993) Posterior interosseous reverse forearm flap: experience with 80 consecutive cases. Plast Reconstr Surg 92:285\u2013293. https:\/\/doi.org\/10.1097\/00006534-199308000-00014","journal-title":"Plast Reconstr Surg"},{"key":"5207_CR28","doi-asserted-by":"publisher","first-page":"3313","DOI":"10.3390\/jcm12093313","volume":"12","author":"JW Tee","year":"2023","unstructured":"Tee JW, Bigdeli AK, Thomas B et al (2023) Reconstruction of hand and foot defects with free serratus carpaccio flap and free serratus fascia flap: a comparative retrospective study of surgical outcomes. J Clin Med 12:3313. https:\/\/doi.org\/10.3390\/jcm12093313","journal-title":"J Clin Med"},{"key":"5207_CR29","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.jhsa.2005.03.016","volume":"30","author":"HT Wang","year":"2005","unstructured":"Wang HT, Fletcher JW, Erdmann D, Levin LS (2005) Use of the anterolateral thigh free flap for upper-extremity reconstruction. J Hand Surg 30:859\u2013864. https:\/\/doi.org\/10.1016\/j.jhsa.2005.03.016","journal-title":"J Hand Surg"},{"key":"5207_CR30","doi-asserted-by":"publisher","unstructured":"Kimura N, Satoh K, Hasumi T, Ostuka T (2001) Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 108:1197\u20131208; discussion 1209\u20131210. https:\/\/doi.org\/10.1097\/00006534-200110000-00015","DOI":"10.1097\/00006534-200110000-00015"},{"key":"5207_CR31","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/s0007-1226(03)00126-7","volume":"56","author":"GL Ross","year":"2003","unstructured":"Ross GL, Dunn R, Kirkpatrick J et al (2003) To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 56:409\u2013413. https:\/\/doi.org\/10.1016\/s0007-1226(03)00126-7","journal-title":"Br J Plast Surg"},{"key":"5207_CR32","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1097\/PRS.0b013e3181c495ed","volume":"125","author":"MM Hanasono","year":"2010","unstructured":"Hanasono MM, Skoracki RJ, Yu P (2010) A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 125:209\u2013214. https:\/\/doi.org\/10.1097\/PRS.0b013e3181c495ed","journal-title":"Plast Reconstr Surg"},{"key":"5207_CR33","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1055\/s-0037-1602724","volume":"33","author":"A Fricke","year":"2017","unstructured":"Fricke A, Rassner M, Kiefer J et al (2017) Donor-site morbidity of free muscle and perforator flaps: comparison of the gracilis muscle flap and the anterolateral thigh flap. J Reconstr Microsurg 33:526\u2013532. https:\/\/doi.org\/10.1055\/s-0037-1602724","journal-title":"J Reconstr Microsurg"},{"key":"5207_CR34","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.bjps.2012.04.032","volume":"65","author":"D Izadi","year":"2012","unstructured":"Izadi D, Paget JT-EH, Haj-Basheer M, Khan UM (2012) Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconstr Aesthetic Surg JPRAS 65:1357\u20131362. https:\/\/doi.org\/10.1016\/j.bjps.2012.04.032","journal-title":"J Plast Reconstr Aesthetic Surg JPRAS"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-024-05207-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-024-05207-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-024-05207-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T15:17:35Z","timestamp":1711466255000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-024-05207-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["5207"],"URL":"https:\/\/doi.org\/10.1007\/s00402-024-05207-7","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,24]]},"assertion":[{"value":"5 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}