Gracilis Muscle Flap for Ankle Soft Tissue Reconstruction: A Systematic Review and Meta-analysis of Postoperative Outcomes
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.024 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".