Anatomic basis for use of a gracilis muscle flap

Abstract

The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. This established the following points: 1) The arterial supply is abundant, consisting of several pedicles reaching the muscle on its deep aspect. The main neurovascular pedicle arises from the deep vessels of the thigh, via either the a. of the adductors (73%), the medial circumflex a. (19.2%) or as a double supply from both arteries (7.7%); 2) The cutaneous vascularisation over the gracilis m., derived from the solitary main pedicle, is inconstant. In 20 injections, it was satisfactory in 11 cases, poor in 5 and absent in 4; 3) The distal tendon of the gracilis m. is closely related to the posterior branch of the saphenous n. to the leg, which it crosses in an elongated X; 4) A simple method of calculation based on the distance between the upper border of the pubis and the medial femoral epicondyle allows quite precise determination of the point of entry of the main pedicle into the gracilis m. 5) Complete dissection of the main pedicle adds to the available length of the muscle flap.

The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study

“…The main vascular pedicle in our study entered the muscle 10 6 1.3 cm from the ischiopubic insertion of the muscle, as literature reports (Juricic et al, 1993;Coquerel-Beghin et al, 2006). This knowledge has great surgical relevance, since the surgeon can easily identify the main vascular pedicle, minimizing the dissection and reducing the risk of iatrogenic damage.…”

“…Being one of the most versatile muscles used in reconstructive surgery, the anatomical features of the gracilis muscle and its pedicular arteries have been investigated in several studies, most of them based on anatomical dissections of human cadaver thighs (Giordano et al, 1990;Yousif et al, 1992;Whetzel and Lechtman, 1997;Hasen et al, 2003;Coquerel-Beghin et al, 2006) or anatomoradiological studies on gracilis muscles harvested from cadavers (Mathes and Nahai, 1981;Giordano et al, 1990;Juricic et al, 1993;Taylor et al, 2002). To the best of our knowledge our study is the first anatomo-radiological analysis of the vasculature of the gracilis muscle carried out in vivo.…”

“…In some studies and anatomical textbooks, the main artery is reported to be a branch of the medial circumflex femoral artery (Giordano et al, 1990;Taylor et al, 2002), whereas other authors indicated that the artery to the adductors was the most common source of the artery of the main pedicle (Juricic et al, 1993;Standring et al, 2005;Coquerel-Beghin et al, 2006). Recently, it has been suggested that these differences could have arisen from misinterpretation of the term ''artery to the adductors,'' as many authors refer to the artery to the adductors as a ''transverse branch of the medial circumflex femoral artery'' (Hussey et al, 2007).…”

New Rectal Construction After Abdominoperineal Resection for Carcinoma Rectum

“…The main neurovascular pedicle arises from medial boarder of adductors and enters at the junction of upper one-fourth and lower three-fourths gracilis at its lateral boarder. After clamping minor vascular pedicles, enough blood supply remained to the distal part of gracilis as detected using laser flowmetry [16,17] in our series of 42 patients; no delay procedure of the gracilis was implemented.…”

Use of a gracilis myocutaneous flap for reconstruction of perineal defect in a dog -Case report

“…The gracilis myocutaneous flap (GMCF) is widely used for reconstruction of skin defects in human medicine (3). The GMCF has been evaluated for treatment of large composite defects and distant transfer in dogs and cats (4,5).…”