The authors report on the first two patients treated using this technique in canada. Urinary and fecal diversion is the firststep operation. Soft tissue management of ankle fractures and use of the gracilis muscle flap. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. This pdf is available for free download from a site hosted by. Anatomy and morphometry of the distal gracilis muscle. A feasibility study in cadavers jamal a mohammad md frcsc, saleh m shenaq md division of plastic surgery, baylor college of medicine, houston, texas, usa the gracilis muscle flap has several applications in reconstructive plastic surgery. Muscle flaps have come to play an invaluable role in the management of complex groin wounds figure 1. Generally will enter muscle about 8 cm from the pubic tubercle. Minimally invasive endoscopic technique of harvesting free gracilis muscle flap to lower donor site morbidity. Pdf the transverse musculocutaneous gracilis flap for breast. Treatment with gracilis muscle flap following vacuum assisted closure therapy. A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief.
Pdf the transverse musculocutaneous gracilis tmg flap has received little attention. The use of the gracilis muscle in reconstructive surgery was first described by pickrell in 1952 for rectal sphincter reconstruction. Gracilis muscle interposition with primary rectal without. The authors retrospectively analyzed the origin and size of the defect, microsurgical success, and early and late. Both pedicled and free flaps can be muscular or musculocutaneos the so called composite flaps. The free gracilis muscle flap in achilles tendon coverage. Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat.
Gracilis muscle free flap transplant facial paralysis. It arises by a thin aponeurosis from the anterior margins of the lower half of the symphysis pubis and the upper half of the pubic arch the muscles fibers run vertically downward, ending in a rounded tendon. Work on superior and inferior surfaces of the muscle belly to free the muscle from surroundings. 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. Innervated pedicled gracilis flap for dynamic abdominal. Functional free muscle flap facial paralysis surgery. The aim of this study was to specify certain anatomic features of the gracilis m. Various techniques of harvesting the free gracilis flap have been described. Anatomic basis for use of a gracilis muscle flap springerlink. Flaps and reconstructive surgery ebook by wei, fuchan. In 1990, obrien was the first to report the use of the gracilis.
Gracilis muscle interposition in conjunction with primary rectal repair but without urethral reconstruction is one of the reconstructive surgery options for moderate 2cm to 3cm rectourethral fistulas. David chweichin chuang, in flaps and reconstructive surgery, 2009. Free gracilis muscle transfer to restore elbow flexion in. 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. Numerous methods have been described to correct these problems.
Internal urethrotomy is a procedure for postoperative urethral strictures of 1. Compared with pedicled mtu flaps, ffmfs are more versatile. Free gracilis muscle coverage of forearm and hand soft. Gracilis is a commonly used muscle for free tissue transfer for small to mediumsized soft tissue defects. Generally passes underneath adductor longus and above adductor magnus, and enters fairly close to a right angle to the gracilis muscle. Muscle flap surgery wmhs plastic surgery cumberland. The gracilis muscle or musculocutaneous flap is the flap of choice in functional motor unit transfers. We have found that the gracilis muscle offers significant advantages over other local muscle flaps.
Video presentation 08 rectovaginal fistula repair using a. Two venae, one usually slightly larger than the artery. Technique of harvesting the gracilis for free functioning muscle. Nerve and free gracilis muscle transfers for thumb and. Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct. Outcome of rectus femoris muscle flaps performed by. The results of this preparatory study show that the gracilis muscle in adults is narrow and long 482 mm on average. Transverse upper gracilis tug flap johns hopkins hospital.
We report the use of gracilis muscle to repair a large urethral defect. Gracilis, tensor fascia lata, vastus lateralis, rectus. We prefer to use pedicled gracilis muscle flaps pgmfs to cover problematic groin wounds when more. It is thin and flattened, broad above, narrow and tapering below. Double free muscle transfer using the gracilis muscles is a potentially effective method. The issues that would negatively impact free flap success should be assessed. The gracilis is less bulky than other muscle flaps and even some fasciocutaneous flaps, such as the scapula or lateral arm in larger patients, although it cannot be used as a sensate flap.
The gracilis muscles of 15 formalinfixed adult cadavers 30 cases were dissected with 4. Muscle conserving free gracilis transfer minigracilis. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap rff, has been performed by plastic and reconstructive. Facial muscles may be removed during tumor excision or damaged by. 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. Since gracilis does not result in much functional deficit, closure to the defect and can be. The distal tendon of gracilis muscle is long, 294 mm on average. Gracilis muscle flap for urologic reconstruction video. A mechanismsoriented protocol for the assessment of chronic pelvic pain and urogenital pain syndromes marek jantos.
The proximally based gracilis muscle and muscu locutaneous flaps. Original article experience with a modified technique of free gracilis transfer gautam biswas, puneet tuli, kavita kalitha. It can be harvested with a skin paddle see tug flap. Minimally invasive endoscopic technique of harvesting free. The video demonstrates creation of a gracilis muscle flap for use in urethral and perineal reconstruction. Gracilis muscle flap for urologic reconstruction youtube.
Free gracilis muscle transfer to restore elbow flexion in brachial plexus injuries. 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. 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. Jeremy myers, from university of utah, demonstrated creation of a gracilis muscle flap for use in urethral and perineal reconstruction.
Check out our before and after images to see how dr. Chronic pelvic abscedation after completion proctectomy in. The problem of partial skinpaddle necrosis with the gracilis myocutaneous flap is well documented in the literature. The gracilis free flap for reconstruction of parotidectomy. The gracilis is the most superficial muscle in the medial compartment of the thigh and descends almost vertically down the medial side of the thigh. Ten human gracilis muscles obtained from adults and ten gracilis muscles collected from human foetuses between the 15th and 21st week of gestation were examined. Some women who have muscle flap surgery still require a breast implant to achieve the final size and shape that they desire. Intraoperative, debridement of wound until brisk bleeding was done. The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. Original article experience with a modified technique of. Double free gracilis muscle transfer after complete. Analysis of the gracilis myocutaneous flap as a workhorse. The gracilis flap is our first choice for the application of functioning free muscle transplantation.
After dissecting the flap and pediculising it, the flap was rotated and fixed to the perineal wound in. Chronic pelvic abscedation after completion proctectomy in a rectal stump insufficiency. Read the transverse musculocutaneous gracilis flap for chest wall reconstruction in male patients with polands syndrome, microsurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available. The gracilis myocutaneous flap was used in this patient to achieve good healing of the area. Gracilis muscle flap for exposed prosthetic graft in. A gracilis muscle flap was raised from the right side using the standard technique and. This technique requires a vaginal stent mold and dilatation. The gracilis muscle or musculocutaneous flap has been the donor muscle preferred by many reconstructive microsurgeons. Experience with a modified technique of free gracilis transfer.
At the dorsal border of the muscle, the main pedicle of the tmg flap is encountered in the adipofascial space. We describe the technique for using pgmfs to provide groin coverage, report a summary of our. Gracilis muscular flap for large urethral defect author. Yuichiro yoshioka, shigeaki moriura, hiroshi yuba, atsushi hirano, ryohei hattori subject. After completion of the resection phase, the patient was submitted to perineal reconstruction using a left myocutaneous flap originating in the left gracilis muscle. Early results with use of gracilis muscle flap coverage of infected. The introduction of radical vulvar surgery and pelvic exenteration in 1950s allowed for the treatment of locally advanced or recurrent cancer with improved survival outcomes. Download atlas of regional and free flaps for head and neck reconstruction or read online books in pdf, epub, tuebl, and mobi format. Double free gracilis muscle transfer after complete brachial plexus injury. Flaps and reconstructive surgery ebook by fuchan wei. Using the gracilis muscle flap vascular specialist. Atlas of regional and free flaps for head and neck. 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. This video describes a technique for gracilis muscle flap for a patient with exposed prosthetic graft in the groin with prior failed sartorius myoplasty in the setting of multiple revascularization procedures.
Soft tissue management of ankle fractures and use of the. The surgeon must extract and relocate skin, blood vessels, muscle, and fat from one area and relocate it using precision techniques to ensure its survival. Despite the variations in viability, the flap proved to be a versatile and totally adequate tool. However, muscle flap selection after failure of treatment with other modalities necessitates diagnosis of the etiology of previous failure. This document was downloaded for personal use only. The transverse musculocutaneous gracilis flap for chest. A 57yearoldman with rectal cancer underwent abdominoperineal resection including part of the prostate and seminal vesicle.
Tongue reconstruction with the gracilis myocutaneous free flap. This pdf is available for free download from a site hosted by medknow publications. Click download or read online button to get atlas of regional and free flaps for head and neck reconstruction. Patients requiring total parotidectomy were recently offered the option of immediate reconstruction of the contour defect with microvascular transfer of a tailored gracilis muscle flap. A surgical video demonstrating the 10 steps of a gracilis muscle flap for treatment of a complex groin wound. There is a degree of contention in the literature regarding the most reliable flap design, dimensions and operative technique. Surgical technique and clinical application of the transverse gracilis. From march of 2003 until march of 2010, the authors performed a series of 20 patients receiving gracilis flaps for defects in the achilles region alone or in combination with concomitant tendon loss. Gracilis muscle is widely used in reconstructive surgery graciloplasty, either as a pedicled flap or as a free microsurgical flap.
Gracilis free flap for smile reanimation iowa head and. As a pedicled flap, gracilis muscle can be used in perineal and vaginal reconstruction, after oncological surgery. In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. This is usually done if patients do not have adequate skin and tissue in the abdomen or buttock region. The multivector gracilis free functional muscle flap for. Gracilis vessels from the medial femoral circumflex system. Pdf perineal reconstruction after abdominoperineal. See figure, supplemental digital content 2 which displays a sketch of the patient after gracilis flap was inset in abdominal defect.
An outcomes analysis, journal of the american college of surgeons on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. As a substitute donor muscle, the gracilis muscle has parallel muscle fiber pennation similar to facial muscles and adequate force generation and excursion for smile restoration. Technique of harvesting the gracilis for free functioning muscle transplantation. The gracilis muscle is located in the inner aspect of the thigh. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to help patients correct their facial paralysis symptoms. The gracilis flap is a common ffmf used in contemporary facial reanimation surgery for smile restoration. Discussion the gracilis flap represents the workhorse for reconstruction of the perineal and pelvic defect.
Gracilis muscle flap is commonly used in reconstructive surgery. Author links open overlay panel jayme augusto bertelli md, phd. An exhaustive set of intraoperative parameters including degree of recoil of the gracilis muscle following harvest, the degree to which the muscle foreshortened during stimulation of the obturator nerve, final stretched length of the inset muscle, surgeon assessment of neurorrhaphy and pulse pressure, ischemia time, number of sutures used. Comments off on soft tissue management of ankle fractures and use of the gracilis muscle flap. The gracilis muscle free flap is generally performed as a 2stage procedure.
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