The Transverse Musculocutaneous Gracilis Flap for Breast Reconstruction: Guidelines for Flap and Patient Selection

Abstract

The TMG flap is more than an alternative to the deep inferior epigastric perforator (DIEP) flap in microsurgical breast reconstruction in selected patients. In certain indications, such as bilateral reconstructions, it possibly surpasses the DIEP flap because of a better concealed donor scar and easier harvest.

The Transverse Musculocutaneous Gracilis Free Flap: Virtual Animation–Assisted Dissection and Application in Breast Reconstruction

“…After having performed a manual subfascial dissection of the gracilis muscle, the distal tendon is blindly cut with extra-long scissors. 13 This technique avoids any unsightly counterincision at the internal tibial condyle. Finally, the muscle is freed proximally, the pedicle is ligated, and the transverse musculocutaneous gracilis flap is delivered to the chest.…”

“…11 The width of the skin island flap measures 8 to 10 cm to ensure a tension-free closure. 13 The dissection starts by the anterior half of the skin paddle. The adipose tissue is transected straight, and the flap is undermined in a subfascial plane up to the anterior border of the gracilis muscle.…”

Pelvic, Perineal and Genital Reconstructions

“…Gracilis muscle or musculocutaneous flap is the method of choice in the perineogenital reconstructions and in the pelvic floor (24). traditional flap design with a vertical skin island is insecure, but according to current knowledge the angiosome for skin circulation is transverse (tMG, transverse myocutaneous gracilis flap) (25,26,27). the transverse skin island allows easier accessibility to the pelvic floor, invisible donor site scars and more reliable skin island.…”

Breast Reconstruction Using the Geometrically Modified Profunda Artery Perforator Flap From the Posteromedial Thigh Region

“…However, this flap has a small and short pedicle, limited flap volume, and a relatively high complication rate. 6,14 At the turn of the century, pedicled and free posteromedial thigh flaps based on profunda artery perforators in the adductor magnus area were applied for a variety of clinical cases. [15][16][17][18] After favoring the SGAP and IGAP flap for breast reconstruction, Allen et al 19,20 were the first to describe the PAP flap as the preferred option when the DIEP flap is unavailable or undesirable.…”