We report a rare case involving a 40-year follow-up of a patient who underwent bilateral free gracilis myocutaneous flap transfers for circumferential scar contracture of the right lower leg due to a childhood burn injury. A flap from the right thigh was transplanted at age 10, followed by a similar flap from the left thigh at age 12. Both the flaps exhibited proportional growth with surrounding tissues and remained supple and elastic. The patient reported no subjective muscle weakness or motor impairment in the lower limbs. Although detailed surgical records were unavailable, ultrasonography and contrast-enhanced computed tomography provided insights into vascular anastomoses and flap perfusion. Sensory evaluation revealed protective or better sensation throughout most of the flaps, with diminished sensitivity only in locally thickened regions near vascular anastomosis sites, likely due to preserved nutrient vessels during debulking procedures. This case presents a rare opportunity to assess the long-term morphological and sensory outcomes of free flap reconstruction, offering valuable insights into flap durability and patient satisfaction over four decades.
