Gracilis Muscle Flap for Ankle Soft Tissue Reconstruction: A Systematic Review and Meta-analysis of Postoperative Outcomes.

Background: The gracilis muscle flap is valuable as a reconstructive option because of its reliable anatomy and minimal donor-site morbidity. The aim of this systematic review was to evaluate acute perioperative complications and long-term outcomes of the gracilis muscle flap in distal lower limb reconstruction following trauma, infections, or oncological resections. Methods: This review was registered with PROSPERO (CRD42023486475) and adhered to PRISMA guidelines. All primary studies on gracilis flaps for lower leg soft tissue reconstruction were included, excluding those with flap recipient sites above the knee, isolated tendon repair, or nonprimary research articles. Searches were performed across Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, and PubMed. Results: Fifty-eight articles involving 1232 patients who underwent lower extremity reconstruction with a gracilis flap were included. Indications for surgery were trauma (n = 146), diabetes (n = 116), oncological (n = 31), infection (n = 27), other (n = 2), and heterogeneous (n = 910). A total of 397 (32.2%) complications were reported. In heterogeneous studies, pooled proportions were 0.22 for acute postoperative complications, 0.17 for recipient-site events, and 0.12 for donor-site morbidity, with oncological and infection cases showing the highest complication rates. The most common complications for each category were total flap loss (79, 6.4%), recipient infection (14, 1.1%), and donor-site scarring (14, 1.1%). Conclusions: The gracilis flap is a reliable option for reconstructing a wide array of soft tissue defects of the distal lower extremity, with modifications to increase its coverage area. The long-term functional and aesthetic outcomes after gracilis flap reconstruction are undescribed.