The gracilis muscle derives its blood supply from the branches of the deep profunda artery as a pedicle. Its vascular supply is provided by a dominant vascular pedicle originating from a branch of the profunda femoris artery. Harvest of an entire gracilis muscle and tendon for use in functional muscle transfer. In lower limb reconstruction, the free gracilis muscle flap is usually chosen for coverage of small. Gracilis muscle flap is commonly used in reconstructive surgery. Gracilis muscle interposition for the treatment of recto. Background the ability to achieve a longterm, stricturefree urethral repair is one of the ongoing challenges of reconstructive urologic surgery.
The reconstruction of large defects after abdominoperineal resections and pelvic exenterations has traditionally been accomplished with vertical rectus myocutaneous flaps vrams. Turbogracilis myocutaneous flap for perineal reconstruction grady b. The gracilis muscle flap is well known to provide the best reconstructive option for major scrotal defects. Both pedicled and free flaps can be muscular or musculocutaneos the so called composite flaps. Outcomes after retroflexed gracilis muscle flap for.
Because it crosses multiple joints, your gracilis performs multiple actions. Reconstruction of perineal defects pubmed central pmc. Comparison of onestage free gracilis muscle flap with two. A gracilis muscle flap, including its tendon, was elevated using a medial thigh incision, with a supplementary incision over the medial aspect of the tibial tuberosity. The gracilis muscle flap as vascularized healthy tissue gives patients with otherwise irreparable obstetric fistulas another option before urinary diversion as 95% are healed. Gracilis muscle flap is an excellent option to assist perineal wound healing after apr for. The gracilis muscle flap is the optimal flap for restoring extremity muscle function, specifically as a functional innervated muscle transfer for flexor or extensor tendons. The use of the gracilis muscle in reconstructive surgery was first described by pickrell in 1952 for rectal sphincter reconstruction. Rectovaginal fistula repair using a gracilis muscle flap. The gracilis muscle flap for irreparable, impossible.
Double free muscle transfer using the gracilis muscles is a potentially effective method. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Double free gracilis muscle transfer after complete. Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula. Its function is to help bring the knees together and bend the hip. If you are suffering from facial paralysis or any other related condition, schedule a consultation regarding receiving gracilis flap surgery with beverly hills. The gracilis muscle flap fulfills all the criteria of an ideal flap for interposition in such situations due to its rich vascular supply and ease of rotation. From the society for clinical vascular surgery outcomes after retro. Reconstruction of large perineal and pelvic wounds using. Discussion the grascilis muscle flap was first described by ryan et al3 for closure of rectouretral fistula. Functional free latissimus dorsi muscle flap to the proximal lower extremity. The technique is a secondary choice for autologous breast. Introduction gracilis muscle is widely used in reconstructive surgery, either as a pedicled flap or as a free microsurgical flap. The gracilis myocutaneous flap was used in this patient to achieve good healing of the area.
A small portion of this muscle with its blood supply artery and vein and nerve can be transplanted in the face to replace the facial muscles that allow you to smile. This muscle originates from the external point of the pubic bone and goes all the way down the midshaft of the tibia. See figure, supplemental digital content 2 which displays a sketch of the patient after gracilis flap was inset in abdominal defect. The gracilis muscle is one of the most extensively used muscles for free tissue transplantation. However, it is nowadays more often applied as a free flap for distant. Proximal muscle end wrapped in a tubed piece of adm after major pedicle vessel ligation persistence of the fistulous tract.
Extended approach to the vascular pedicle of the gracilis muscle flap. The mean time of the initial contraction of the muscle flap in the onestage group 5. The gracilis muscle or musculocutaneous flap has been the donor muscle preferred by many reconstructive microsurgeons. Flap dissection was performed in the usual fashion, with care taken to safeguard the great saphenous vein proximally and the saphenous nerve distally. A tug flap reconstruction transfers this muscle, together with adjacent skin, fat and blood vessels, from the upper inner thigh to the chest to create a breast mound. Right gracilis muscle flap was reused as a walking flap plastic surgery the meeting 20. Gracilis muscular flap for large urethral defect author. The multivector gracilis flap design is effective in improving all components of the smile display zone and has the potential for producing periorbitalwrinkling characteristic of a duchenne smile. Lower lip reconstruction using a functioning gracilis.
A 57yearoldman with rectal cancer underwent abdominoperineal resection including part of the prostate and seminal vesicle. The belly of the muscle can be rotated and inserted as a flap between the rectum and adjacent organs during the repair of fistulas, or used as filler for the repair of nonhealing perineal wounds, with the option of harvesting an island of skin from the medial aspect of the thigh as a myocutaneous flap. The multivector gracilis free functional muscle flap for. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The adductor longus muscle becomes taut and felt easily and the gracilis lies along a line 2 finger breadths below and parallel to. It also has a greater arc of rotation and minimal restrictions in postoperative ambulation. Two venae, one usually slightly larger than the artery.
Free gracilis muscle flap for sarcoma reconstruction. In addition, the skin a branch to the gracilis muscle as well as the overlying island cannot be very long since the traditional gracilis myo skin and sartorious muscle. The transverse upper gracilis free flap is a welldescribed option for breast reconstruction. Gracilis vessels from the medial femoral circumflex system. Breast reconstruction usin a transverse upper gracilis. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. Turbogracilis myocutaneous flap for perineal reconstruction. Functioning free gracilis muscle transfer for restoration. Gracilis muscle interposition flaps were performed in 35 patients aged 3878 years, mean. The gracilis muscle is located on the medial aspect of the thigh between the adductor longus anteriorly and the adductor magnus posteriorly. We are presenting a case where a free gracilis muscle flap used to cover the soft tissue defect at the achilles tendon at 2 years follow up provided stable cover and produced active function of. This muscle also assists in knee stabilization and knee rotation. Using the innervated gracilis muscle, the torn rectus abdominis muscle and fullthickness defect in the abdominal wall musculature was reconstructed spanning the length of the right abdomen fig. The gracilis muscle is located in the inner aspect of the thigh.
The main function of the gracilis muscle is to facilitate hip adduction and to help with knee flexion. Moursi, md,a ruosu an, md,a horace spencer, ms,a steven rueda, md,c and john f. Overview of muscle flaps a classification system for muscle and musculocutaneous flaps, described by mathes and nahai in a 1981 prs publication, to date, the have been no alternative classification for muscle flaps commonly used in clinical practice. Retroperitoneal urinoma spontaneously drained in the. Gracilis muscle musculus gracilis attachments of gracilis. Perform gracilis stretching and strengthening exercises to improve sports performance and reduce risk of injury. A novel use of the gracilis muscle as a walking flap for.
Gracilis flap harvest can be performed simultaneously along with the neck exploration. Proximal medial surface of tibia part of pes anserinus. It can be harvested with a skin paddle see tug flap. This technique called graciloplasty was described in the 1950s by pickrell 5 and was revolutionized in the late 1980s by the introduction of chronic muscle electrostimulation. The thigh is kept flexed to 30 degrees, and externally rotated. Conclusions and relevance the gracilis flap can be reliably designed as a functional double paddle muscle flap for a multivector facial reanimation. The ratio of contraction of the affected side compared to the normal side was similar in both groups. Muscle flaps such as the latissimus, 7 partial latissimus, rectus, and gracilis flaps can also reconstruct a large variety of wounds fig.
This pedicle, located 8 to 12 cm from the gracilis origin on the pubic ramus, is 4 to 6 cm long. Yuichiro yoshioka, shigeaki moriura, hiroshi yuba, atsushi hirano, ryohei hattori subject. It crosses from the lower end of your pelvis to the top of your tibia, the larger of the two bones in your lower leg. The muscle is completely expendable and provides bulk. Described by mcgraw in 1976, 21 the gracilis flap consists of a transversely orientated crescent of skin and fat at the crease between perineum and thigh and the underlying gracilis. Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct.
These muscles, often called groin muscles, pull the leg in toward the body. The gracilis free flap uses tissue and muscle from the donor area and is most often used when an area of the face is indented because of trauma, or birth defect in the face or neck. We report the use of gracilis muscle to repair a large urethral defect. 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. Area enlargement of the gracilis muscle flap through. Pdf perineal reconstruction after abdominoperineal. Muscle flaps mathes and nahai classification for muscle.
Methods we describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair. The free gracilis muscle flap in achilles tendon coverage. Discussion the gracilis flap represents the workhorse for reconstruction of the perineal and pelvic defect. They can be elevated at a later date for secondary surgery.
The gracilis muscle is a broad sheettype shape that can be wrapped around the defect and does not add much bulk to the reconstructed scrotum. Gracilis muscle flap for recurrent rectovaginal fistula. Gracilis muscle flap is an excellent option to assist perineal wound healing after apr for both rectal cancer and anal cancer with minimal complications at both the donor site and. For patients requiring two ostomies, robotassisted abdominoperineal resections aprs, and to avoid the morbidity of a vram harvest, the authors have used the gracilis muscle flap to reconstruct the large. Our study was designed to assess the efficacy of the gracilis muscle flap in repairing rectourethral and rectovaginal fistulas. Innervated pedicled gracilis flap for dynamic abdominal. Rectu m vagina proximal end of the gracilis muscle distal end of the gracilis muscle. The main advantage of this flap is that the donor site morbidity is minimal.
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. The gracilis muscle, along with four other muscles pectineus, adductor longus, adductor brevis and adductor magnus make up the adductor muscle group. Double free gracilis muscle transfer after complete brachial plexus injury. In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. Perineal reconstruction after abdominoperineal resection using gracilis muscle flap. The technique of utilizing a single gracilis functional. The transverse upper gracilis muscle is located in the inner thigh. Analysis of the gracilis myocutaneous flap as a workhorse. Sarcoma treatment necessitates highdose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Gracilis muscle free flap transplant facial paralysis. Ali, md,a mario rueda, md,b sarasijhaa desikan, md,a mohammed m.
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