Safe mobilisation of transverse upper gracilis flap in patients with hip replacements

Background: The transverse upper gracilis (TUG) flap is easily harvested to recruit a fair volume of tissue from the inner upper thigh region, making it the second choice of certain authors. Hip replacement is deemed prohibitive due to positional requirements that predispose to anterior dislocation of prosthetic femoral heads. In this report, we describe a simple and safe way to raise TUG flap in patients with existing hip prostheses, detailing patient assessments, and technical variations in a limited case series.

Material and methods: A retrospective single cohort study was conducted on patient who underwent TUG flap-based reconstruction after hip replacement. Hip joint instability was assessed clinically and with CT. Flap harvesting was performed to prevent the extra-rotation of the femoral head by the thigh flex or dissecting the pedicle keeping the thigh straight.

Result: Eleven patients were qualified for the study, and the flap raising time was superimposable to the conventional technique. Six flaps were elevated, while the thigh was kept in the flexed position without any extra-rotation, and the pedicle dissection was completed in 5 cases by keeping the thigh in the straight position. No intra- or postoperative hip dislocations resulted. All patients ambulated on mornings after surgery, returning to daily activities within 4 weeks.

Conclusion: TUG flap is a viable alternative that is not necessarily prohibited by existing prosthetic hips. Careful patient assessment and positioning during surgery are key considerations for safe and successful procedures.