To date, the have been no alternative classification for muscle flaps commonly used in clinical practice. Since 1983, 21 gracilis muscle flaps were used in 19 patients at this department. It can be used either as a pedicled flap, or as a free flap. Flap revision surgery aesthetic plastic surgery, pc.
This myocutaneous flap uses the medial circumflex artery and venae comitantes to reliably perfuse a sizable. It should help clarify some questions that you may have. Gracilis flaps for breast reconstruction plastic surgery key. Tug flap breast reconstructive surgery information sheet this information sheet is a general guide for patients undergoing a transverse upper gracilis tug flap breast reconstruction under the care of mr paul harris. We describe a technique of harvesting a small unit of gracilis based on its minor pedicle and maintaining the continuity and conserving the major bulk of muscle. Since it is composed of fat, the omental pedicle flap does not typically enhance after intravenous contrast material administration. Gracilis muscle flap is commonly used in reconstructive surgery. Urologygracilis flap placement urology coding ask an.
The rectus abdominis myocutaneous flap has been used as the first choice for pelvic and perineal reconstruction. The gracilis muscle flap for irreparable, impossible. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. It serves as a mechanical barrier between the urethra or. The gracilis flap is a good choice for perineal wounds should you be opting for a gracilis flap. Lower lip reconstruction using a functioning gracilis. The role of intrathoracic free flaps for chronic empyema. Gracilis muscle has a class 2 vascular pedicle, with a dominant vascular. While the abdominal donor site is often the first choice for autologous breast. Modern perforator flap imaging with highresolution blood.
In addition, the effect of anaesthetics on pig muscle is known lundeen, 1983sigurdsson, 1994. Analysis of the gracilis myocutaneous flap as a workhorse flap for. Find, read and cite all the research you need on researchgate. Anterolaterally, it is covered by the adductor longus and posterolaterally, at its proximal third, it is related to the adductor magnus. This article outlines the various preoperative imaging modalities for perforator flap imaging, such as doppler ultrasonography us, computed tomography ct, and magnetic resonance mr angiography, with a focus on highspatialresolution blood pool mr angiography and our flapspecific protocols.
However, due to previous abdominal surgery and multiple stoma placements in our patients, the rectus abdominis myocutaneous flap could not be used for such reconstruction. Gracilis free flap harvesting technique coverage youtube. Surgical technique and clinical application of the transverse gracilis. Background traditionally, the gracilis free flap is used for coverage of small to mediumsized wo. The computeraided design cad files and all associated content posted to this website are created, uploaded, managed and owned by third party users. Various techniques of harvesting the free gracilis flap have been described. A foundation explanation of blood supply to muscles and musculocutaneous flaps can be read here. Although the authors highlighted some useful technical refinements after experience with 32 flaps in 20 patients, they forgot to cite essential references regarding breast reconstruction with the transverse gracilis flap. Two venae, one usually slightly larger than the artery. The gracilis muscle flap as vascularized healthy tissue gives patients with otherwise irreparable obstetric fistulas another option before urinary diversion as 95% are healed. According to the classification of mathes and nahai, it presents a type ii blood supply, allowing it to be transferred on its artery derived from the medial circumflex femoral artery. A case of complication after a degloving operation of.
Each flap was inset under adequate resting tension such that functional thumb opposition would occur with gracilis contraction. This is usually done if patients do not have adequate skin and tissue in the abdomen or buttock region. The transverse musculocutaneous gracilis tmg flap has become a common solution for breast reconstruction. The authors report a case of complex rectovaginal fistula together with sphincter incontinence treated by gracilis musculocutaneous flap at the same time. Lower lip reconstruction using a functioning gracilis muscle free flap article pdf available in seminars in plastic surgery 242. The gracilis muscle or musculocutaneous flap has been the donor muscle preferred by many reconstructive microsurgeons. Figure 2schematic drawing of medial view of the thigh showing the. The gracilis flap is an exciting alternative to abdominal, back, or buttock.
Facial muscles may be removed during tumor excision or damaged by. Gracilis muscle free flap transplant facial paralysis. Vaginal reconstruction washingtonian plastic surgery. Our study was aimed to describe the vascular anatomy of the gracilis muscle and the related skin, in order to have a better understanding of the skins blood supply, and to help in determining a safer cutaneous paddle. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in crohns disease. Functioning free gracilis transfer to reconstruct elbow. A singapore flap was not possible because of extension of the defect onto the medial aspect of the thigh. Original article experience with a modified technique of.
In this study, we attempted to address this issue based on our experiences with. In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. Technique of harvesting the gracilis for free functioning muscle. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. Hence, the amt flap can be separated from other medial thigh flaps such as the transverse upper gracilis flap or the medial geniculate artery flap based on the blood supply. The gracilis muscle or myocutaneous flap is a mathes and nahai neurovascular flap type ii. Gracilis muscle flap for urologic reconstruction duration. Lin, harvard medical school, united states of america. Gracilis muscle interposition for the treatment of recto. Transverse upper gracilis flap for breast reconstruction.
Other substances have been recommended as variations on the technique. Muscle conserving free gracilis transfer minigracilis free flap ncbi. Here, we describe the use of bilateral gluteal fold flaps for pelvic and. Reconstruction for congenital deformities is covered under the topic of urogenital reconstruction, while penile and vaginal reconstructions are covered separately in this journal. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in globalbrachialplexusinjured patients. Tongue reconstruction with the gracilis myocutaneous free flap. Depending on the indication, the gracilis flap can be used as a local flap based on its arc. The gracilis flap is known to be used in hernia repair in which the abdominal. The gracilismyocutaneous flap is useful in reconstruction of. Transverse upper gracilis tug flap johns hopkins hospital. The gracilis muscle free flap is generally performed as a 2stage procedure. The gracilis muscle is commonly used as a flap in microsurgery. The omental pedicle flap may be overlooked at crosssectional imaging, since it has fat attenuation at both ct and mr imaging and may be mistaken for normal pelvic fat fig 2c 9.
The transverse gracilis myocutaneous flap was dissected in the subfascial plane to. Perineal reconstruction may be divided into genitourinary reconstruction for acquired and congenital deformities and reconstruction for cancer. The transverse upper gracilis flap provides a similar tissue quality but has decreased volume and a shorter pedicle, sacrifices the gra. Just as breast implant reconstruction is typically done in stages, natural tissue breast reconstruction frequently requires secondary revision surgery to achieve an optimal breast shape. Both flaps were covered with a split thickness skin graft and in each case there was careful preservation of the gracilis. The key to this technique is to incise and remove all excess connective tissue but to. The gracilis muscle is a wellknown free flap in reconstructive surgery for repairing different kinds of defects, such as facial palsy, total tongue reconstruction, muscle replacement in the upper limb, and several soft tissue repairs. Horton introduction the inner thigh skin and fat based on the transverse upper gracilis tug musculocutaneous flap blood supply provides an autologous donor area with several qualities complementary to microvascular breast reconstruction.
Experience with a modified technique of free gracilis transfer. Thrombosis and bowstringing were the most common short and longterm complications. Video presentation 08 rectovaginal fistula repair using a. Trauma and urologic reconstruction network of surgeons turns 12,419 views. Vascularisation of urethral repairs with the gracilis muscle flap ee hsiang jonah kua, kah woon leo, yee siang ong, christopher cheng, bienkeem. Reconstructive surgery after treatment of female genital. Pig muscle flap vascular resistance ubc library open. A case of complication after a degloving operation of melanoma of the penis repairing urethrocutaneous fistula with a pedicled gracilis flap by hl liu. Tug flap breast reconstructive surgery information sheet. The gracilis free flap is a viable option for large extremit. Pdf the transverse musculocutaneous gracilis flap for breast. A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief. Vascularisation of urethral repairs with the gracilis. Based on our outcomes, we note the possible advantage of incorporating the gracilis flap even when it is thought that the singapore flap is sufficient.
Reconstructive surgery after treatment of female genital tract malignancies. Pdf the transverse musculocutaneous gracilis tmg flap has received little. The transverse upper gracilis tug flap harvests this skin and fat in a horizontally oriented ellipse along the medial aspect of the thigh, which was initially described by yousif et al in 1992, with the first clinical reports in 1993. The gracilis myocutaneous flap is favoured by many reconstructive surgeons.
Role of mr imaging and fdg petct in selection and follow. The flap has an adequate length, can be rotated easily into the perineum and brings wellvascularised muscle to irradiated or traumatised tissue. The gracilis muscle flap is another option for the repair of fistulas. However, secondary to trauma or previous surgical procedures, a pedicle flap may. Yu p et al discussed about the anatomy of the anteromedial thigh flap and defined its blood supply to be derived from the rfb because of its longer and larger calibre pedicle. Check out our before and after images to see how dr. Efficiencies and design tips edward w buchel bsc md facs, kimberly r dalke msc, thomas ej hayakawa md frcsc section of plastic surgery, university of manitoba, winnipeg, manitoba. Muscle flaps mathes and nahai classification for muscle. Refining the outcome of flap breast reconstruction. The management of chronic empyema associated with a bronchopleural fistula can be a particularly challenging problem. The free gracilis muscle flap in achilles tendon coverage. We read with great interest the article by buntic et al. The portion of the pouch closest to the viewer becomes the posterior wall of the vagina.
A mechanismsoriented protocol for the assessment of chronic pelvic pain and urogenital pain syndromes marek jantos. Cleveland clinic florida colorectal chairman steven wexner, md, examines the evidence in our viewpoints series. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful. View the article pdf and any associated supplements and figures for a period of 48 hours. Functional free muscle flap facial paralysis surgery.
However, the safe skin paddle limits are not yet understood. Once healing is complete following the first stage of flap breast reconstruction, any potential contour problems can be. Operative view demonstrating the retracted adductor longus muscle. Vaginal reconstruction 445 d figure 5 unilateral gracilis myocutaneous flaps a, preoperative view showing a partial vaginal defect. Gracilis myocutaneous flap, iscial pressure sore, perineal.
Use of gracilis musculocutaneous flap in the treatment of. A low morbidity alternative to the tug, gap, and pap flaps erez dayan, m. A 2stage procedure with a crossface nerve graft followed by gracilis free flap inset is advocated. Gracilis vessels from the medial femoral circumflex system. Repair of a fistula between the bladder and the perineal. The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. It can be harvested with a skin paddle see tug flap. Innervated pedicled gracilis flap for dynamic abdominal wall.
In this article, the anatomy of the gracilis muscle, alternative neural sources including the masseteric nerve, and. Pedicled muscle flaps for coverage on the thorax have been well described. Vascular anatomy of the anteromedial thigh flap jpras open. Rotation of the pouch posteriorly into the pelvic defect will occur. Gracilis transposition in complicated perianal fistula and.
The free gracilis muscle flap in achilles tendon coverage and reconstruction article in plastic and reconstructive surgery 1294. Because of high recurrence rate in the treatment of complex rectovaginal fistula, a vascularized tissue transfer is required, especially in postmenopausal women. To our knowledge, this is the first report of the use of a gracilis muscle as a walking flap for repair of a rectovaginal fistula, and should be considered as an alternative appropriate treatment for persistent rectovaginal fistulas after failure of initial gracilis muscle interposition flap. Gluteal fold flap for pelvic and perineal reconstruction. The transverse upper gracilis tug flap uses tissue from the inner upper thigh near the natural groin crease, as well as the gracilis muscle, to create breast tissue.
Depending on the indication, the gracilis flap can be used as a local flap based on its arc of rotation for local wound coverage or reconstruction. Gracilis myocutaneous flap for perineal defect reconstruction after left hemivulvectomy for locally invasive vulvar. This pdf is available for free download from a site hosted by medknow publications. Two pedicled flaps were lost, possibly due to an intraoperative spasm of the feeding. This is video power point presentation of gracilis muscle flap conplete reading on anatomy harvesting technique and practical diffiuculty of flap harvest and various uses in coverage of the. We present a surgical technique in which the gracilis is harvested. In 1990, obrien was the first to report the use of the gracilis. Modified technique of gracilis flap harvest condyle between the sartorius and semitendinosus muscles. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to help patients correct their facial paralysis symptoms. Tongue reconstruction with tmg free flap 357 microsurgery doi 10. However, it is nowadays more often applied as a free flap for distant. Successful eradication may not occur without interposition of healthy vascularized tissue. A novel use of the gracilis muscle as a walking flap for.
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