Friday, February 1, 2008
13810

Mini Gracilis Free Flap

Rami Ghurani, MD, Jaime Perez, MD, Kenneth Robert Lee, MD, and Donna Smith, Jr, MD.

The gracilis muscle flap has long been utilized in reconstructive surgery for its versatility. It has most extensively been utilized as a pedicled flap in the region of the perineum to correct perineal defects, ischial tubercle, and the vagina, as well as in an extensive array of other locations, by using it as a free flap. These techniques have primarily been based on the main proximal dominant pedicle of the gracilis muscle, the medial circumflex artery. It use has become widespread for several well-documented reasons: it is a thin-strap shaped muscle allowing for an ease in the dissection and harvest, the donor site is associated with minimal morbidity. The donor site may been closed primarily with good cosmesis, and inclusion of anterior branch of the obturator nerve provides functionality to defects necessitating innervation. The flap can be designed with a proximal transverse of longitudinal skin paddle with very predictable success rate. For the aforementioned reasons and several others, the gracilis flap has been heralded by many as a first option for small to medium-sized defects requiring free flap tissue. While this free flap has been described as a workhorse for medium-sized defects, little attention has been paid to the use of a segmental gracilis free flap based on segmental perforators for free tissue transfer to smaller defects. Use of this smaller segmental flap spares the patient a larger surgical harvest, and maintains the functionality of the gracilis muscle, and is a deserved addition to any reconstructive armamentarium. This presentation details a series nine cases involving segmental gracilis free flaps. The distal segmental Gracilis based on the secondary pedicles arising from the superficial femoral artery located on the average 17 cm from the medial epicondyle of the femur. These were employed in the coverage of small upper and lower extremity defects