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Introduction: The transverse upper gracilis (TUG ) flap has been successfully used in breast reconstruction.1 However concerns regarding wound healing, potential for lymphedema, and cosmesis at the donor site have limited its widespread use.2 We describe a new oblique skin paddle design along Langer's lines that allows for abundant soft tissue harvest and minimizes the risk of donor site morbidity. The anterior border of this flap never violates the femoral triangle where lymphatics from the lower extremity traverse. The purpose of this study is to describe this new method for flap harvest and evaluate the outcomes of this technique.
Methods: A retrospective study was performed on 9 consecutive patients who underwent 10 diagonal upper gracilis (DUG) flaps. Preoperative magnetic resonance angiography (MRA) was used to identify the optimal donor thigh. Intraoperative video of this technique will be presented. Cosmetic outcome, fat necrosis, donor site morbidity, and surgical complications were evaluated.
Results: Two flaps were performed for partial breast reconstruction and 8 flaps were used for post-mastectomy reconstruction. All flaps survived. The flap weights ranged from 114 grams to 210 grams. All patients ambulated without restriction on post-operative day one. All donor sites healed uneventfully without pain, seroma, or lower extremity lymphedema. There was no palpable fat necrosis in any of the patients. All patients were satisfied with their cosmetic outcome at both the donor and recipient sites.
Conclusion: The DUG flap is a safe alternative for breast reconstruction. It is useful in the thin patient who lacks volume in the abdominal donor site. Orientation along Langer's lines allows for greater recruitment of tissue while minimizing the potential for wound healing delay and scar widening. The scar is not visible from the frontal view, and only a portion of the scar is visible posteriorly in the middle third of the thigh. This design avoids the transverse scar of the TUG which often widens and may distort the aesthetic appearance of the gluteal crease.
