To date, the have been no alternative classification for muscle flaps commonly used in clinical practice. Gracilis myocutaneous flap10,11 reconstruction of perineal defects. Many techniques for both static and dynamic facial reanimation have been described. Surgical technique performing a free muscle flap for function differs from doing a free muscle flap for cover in the following ways.
We read with great interest the article by buntic et al. Analysis of the gracilis myocutaneous flap as a workhorse. Superficial skin markstitch placed on skin over vessels. Both for wound coverage, and as a functional muscle transplant, the gracilis has. Background mastectomies are one of the most common surgical procedures in women of the developed world. The technique is a secondary choice for autologous breast. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. Qualityoflife improvement after free gracilis muscle.
A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief. Strauch b, vasconez lo, hallfindlay ej eds grabbs encyclopedia of flaps. The gracilis flap is our first choice for the application of functioning free muscle. The gracilis muscle as a free vascularized flap was first described by harii, ohmori, and torii in. The gracilis muscle is located in the inner aspect of the thigh. Freeflap breast reconstruction is a type of autologoustissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. The gracilis vessels were anastomosed to the thoracodorsal artery and.
Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. Request pdf the gracilis free flap the gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. The unreliability of the distal skin component of the gracilis myocutaneous free flap has been frequently reported. Then this was laid posterior to the anastomosis and the muscle flap was laid anterior over the suture line and tacked in. Facial palsy affects both the functional and aesthetic aspects of the face. The gracilis is a very versatile flap that is an excellent choice for its ease of harvesting and minimal donorsite morbidity. 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. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection.
First canadian experience kate elzinga md1, kevin j zuo bsc2, jaret l olson md frcsc1, michael morhart md frcsc1, sasha babicki2, k ming chan md frcpc2,3 1division of plastic surgery. 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. Importance facial paralysis can contribute to disfigurement, psychological difficulties, and an inability to convey emotion via facial expression. This technique uses a long neural pedicle with primary contralateral. However, little is known about the impact on diseasespecific quality of life. Muscle flaps mathes and nahai classification for muscle. In the present case, we used a gracilis muscle flap to cover the tissue loss area. The second free muscle transfer was performed 11 months postinjury to further enhance elbow flexion and to restore wrist and finger flexion. Many studies based on cadaveric dissection have focused on the vascular anatomy of the gracilis muscle providing uncertain. The transverse orientation of the flap allows for a large skin paddle, with some independence from the muscle below. 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.
Gracilis free flap harvesting technique coverage duration. Manktelow rt, zuker rm 1990 microvascular free gracilis muscle and musculocutaneous flap to the forearm. In this article, the anatomy of the gracilis muscle, alternative neural sources including the masseteric nerve, and. The complex soft tissue defects of the lower limb are a common and usually a challenging problem. If you are suffering from facial paralysis or any other related condition, schedule a consultation regarding receiving gracilis flap surgery with beverly hills. A quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction. Free gracilis muscle flap for sarcoma reconstruction.
Transverse upper gracilis tug flap johns hopkins hospital. Outside of maryland toll free 41046467 request an appointment medical concierge services. Successful limb salvage through staged bypass combined. As a type of plastic surgery, the freeflap procedure for breast reconstruction employs tissues, harvested from another part of the womans body, to create a vascularised flap, which is equipped with its own. The linear incision in the medial thigh is made at the inferior border of the adductor longus to expose the. In patients unable to perform a meaningful smile, free gracilis muscle transfer fgmt can often restore smile function. 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. Both sustained traumatic brachial plexus root avulsion injuries resulting in a flail arm. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to. Other substances have been recommended as variations on the technique. This study quantifies the fasciocutaneous vascular.
Barrie et al1 reported 79% and 63% m4 or more outcome following single and double muscle transfer respectively. Along with hassan and kumars,14 report in 2002, a new method of onestage free. However, the rather slim and long shape of the gracilis muscle was considered suitable. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. The authors report on the first two patients treated using this technique in canada. The gracilis flap is a common ffmf used in contemporary facial reanimation surgery for smile. The gracilis muscle free flap is based on a single anatomically constant. A quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction iain s.
Compared with pedicled mtu flaps, ffmfs are more versatile. There is a degree of contention in the literature regarding the most reliable flap design, dimensions and operative technique. The standard and classic method in treatment of patients with chronic facial palsy has been the twostage free gracilis flap for the last 20 years 1 fig. The authors describe their experience with the gracilis free flap and the myocutaneous gracilis free flap with reconstruction of head and neck defects. However, it is nowadays more often applied as a free flap for distant. Check out our before and after images to see how dr. The gracilis muscle or musculocutaneous flap has been the donor muscle preferred by many reconstructive microsurgeons.
In 1990, obrien was the first to report the use of the gracilis free flap for singlestage facial reanimation. Functioning free gracilis muscle transfer for restoration. Fourteen animals underwent free transfer of a gracilis myocutaneous flap comprised of the gracilis muscle and overlying skin, each tissue supplied by independent branches of the femoral vessels. Facial muscles may be removed during tumor excision or damaged by trauma. Dynamic reanimation of smile in facial paralysis with. Gracilis flaps for breast reconstruction plastic surgery key. The most common indication for gracilis free flap in head and neck reconstruction is for dynamic mid and lower facial. In an attempt to obtain the best postglossectomy functional reconstruction, we used the free functional gracilis muscle flap in patients undergoing surgical treatment of oral cavity cancer. The gracilis free flap for reconstruction of parotidectomy. Background the ability to achieve a longterm, stricturefree urethral repair is one of the ongoing challenges of reconstructive urologic surgery. Functioning free gracilis transfer to reconstruct elbow.
Surgical technique and clinical application of the transverse gracilis. Gracilis free flap for smile reanimation iowa head and. The cutaneous perforators of the gracilis muscle supply both the anterior and posterior inner thigh skin reliably. The most frequently used freemuscle flaps for the lower extremities are the latissimus dorsi and rectus abdominis, and the gracilis muscle is usually a third choice 8,9,10. Thrombosis and bowstringing were the most common short and longterm complications.
Urologygracilis flap placement urology coding ask an. The right free gracilis muscle was harvested and then secured proximally to the second rib and distally to the flexor digitorum profundus and flexor pollicis longus tendons figure 1b. Both pedicled and free flaps can be muscular or musculocutaneos. The gracilis muscle is widely used in reconstructive surgery as either a pedicled or free flap for soft tissue coverage or as a functioning muscle transfer. Introduction the gracilis flap was described in 1972 by orticochea, as a pedicled myocutaneous flap, and the first cases included a penile reconstruction and one of calcaneal soft tissue coverage. Here, we present our series of facial reanimation using the functioning free gracilis muscle flap innervated by the masseteric nerve. The transverse upper gracilis free flap is a welldescribed option for breast reconstruction. The free gracilis muscle flap in achilles tendon coverage. A 2stage procedure with a crossface nerve graft followed by gracilis free flap inset is advocated. Innervated pedicled gracilis flap for dynamic abdominal. The multivector gracilis free functional muscle flap for.
A foundation explanation of blood supply to muscles and musculocutaneous flaps can be read here. Then do vessel anastomosis, then neurorraphy, then distal lateral insetting. Comparison of onestage free gracilis muscle flap with two. Functional muscles may be transferred as pedicled regional muscle tendon unit mtu flaps eg, temporalis tendon transfer or as free functional muscle flaps ffmf eg, gracilis flap. 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. Double free gracilis muscle transfer after complete. Abstractgracilis muscle flap is commonly used in reconstructive surgery. Methods we describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair. However, little attention has been paid to the usefulness of the free gracilis muscle flap for covering these challenging defects. Request pdf the free gracilis muscle flap in achilles tendon coverage and reconstruction the achilles tendon area is a delicate one, and therefore numerous publications describe methods of.
The gracilis muscle free flap is generally performed as a 2stage procedure. Two venae, one usually slightly larger than the artery. The gracilis free flap is a viable option for large extremit. The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. Gracilis muscle is widely used in reconstructive surgery graciloplasty, either as a pedicled flap or as a free microsurgical flap. Demonstrate the experience in tongue reconstruction with free functional flap of the gracilis muscle. 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. Functional free muscle flap facial paralysis surgery. Here, we report our experience with a gracilis myocutaneous free flap in massachusetts general hospital miniature swine as a preclinical vca model. Gracilis vessels from the medial femoral circumflex system. Gracilis free flap harvesting technique coverage youtube. Both pedicled and free flaps can be muscular or musculocutaneos the so called composite flaps.
It can be harvested with a skin paddle see tug flap. Pdf free gracilis flaps versus free anterolateral thigh flaps in. In this study, we describe our experience using the free gracilis muscle flap as a firstline approach to softtissue reconstruction after sarcoma extirpation in a variety of anatomical locations. Gracilis muscle free flap transplant facial paralysis. It was one of the first myocutaneous flaps described in humans, and in 1976, harii published a series of gracilis free flaps for soft tissue. 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.
This is video power point presentation of gracilis muscle flap conplete reading on anatomy harvesting technique and practical diffiuculty of. 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. Transverse upper gracilis flap for breast reconstruction. Gracilis muscle is widely used in reconstructive surgery, either as a pedicled flap or as a free microsurgical flap. Gracilis myocutaneous free flap american head and neck society. Not sure of 15734, that is what i thought at first, but all he did was after plastics harvested the gracilis flap and it was separated, dr. The free gracilis muscle flap in achilles tendon coverage and reconstruction article in plastic and reconstructive surgery 1294.
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