The technique of utilizing a single gracilis functional muscle transfer to restore quadriceps function following sarcoma surgery

Aim: Quadriceps strength and knee extension, the most important factors limiting the ability to rise from a chair, are crucial for walking at an appropriate speed, ascending and descending stairs, and performing activities such as running, dancing, and jumping. Resection of the anterior compartment of the thigh, including all four quadriceps muscles, for the treatment of a sarcoma is uncommon; however, when necessary, it is very debilitating and adversely affects a patient's quality of life without functional reconstruction. Currently, there are a limited number of complex and difficult reconstructions to restore quadriceps function that have been described with variable outcomes. We describe a simple technique that employs a single gracilis functional muscle transfer to replace essential quadriceps function. Methods: This is a case series describing the use of either a free or pedicled single gracilis muscle to restore quadriceps function following sarcoma resection. Results: Four patients underwent an anterior compartment sarcoma resection that resulted in a large segmental defect and/or denervation of all four quadriceps muscles such that no quadriceps function would remain without reconstruction. All four patients underwent a functional reconstruction using a single gracilis. Three of the living patients achieved British Medical Research Counsel Grade 4 strength, can achieve full knee extension, are able to navigate stairs, and are able to ambulate without a brace. The fourth patient unfortunately was deceased in under three months following his tumor resection. Conclusion: Despite its small size in comparison to the quadriceps muscles, with physiotherapy and training, the gracilis muscle demonstrates the capacity to hypertrophy and replace quadriceps function following limb salvage surgery.