Jun 01, 2017 gracilis flap for perineal closures in minimally invasive abdominoperineal resection. Dr edward w buchel, section of plastic surgery, department of surgery, gc404, 820 sherbrook street, winnipeg. Efficiencies and design tips edward w buchel bsc md facs, kimberly r dalke msc, thomas ej hayakawa md frcsc section of plastic surgery, university of manitoba, winnipeg, manitoba correspondence. The gracilis muscles of 15 formalinfixed adult cadavers 30 cases were dissected with 4. The gracilis myocutaneous flap is favoured by many reconstructive surgeons. This technique uses a long neural pedicle with primary contralateral. Gracilis muscle flap is commonly used in reconstructive surgery.
Internal urethrotomy is a procedure for postoperative urethral strictures of 1. The gracilis muscle is a broad sheettype shape that can be wrapped around the defect and does not add much bulk to the reconstructed scrotum. The gracilis muscle is located in the inner aspect of the thigh. Muscle conserving free gracilis transfer minigracilis free flap ncbi. Modern perforator flap imaging with highresolution blood. The editor of the british journal of plastic surgery kindly gave permission for. Video presentation 08 rectovaginal fistula repair using a. Dynamic reanimation of smile in facial paralysis with. Gracilis free flap harvesting technique coverage youtube. The gracilis muscle is a wellknown free flap in reconstructive surgery for repairing different kinds of defects, such as facial palsy, total tongue reconstruction, muscle replacement in the upper limb, and several soft tissue repairs.
Gracilis myocutaneous flap in reconstruction of the vulva and. Jun 24, 2019 the gracilis muscle free flap is generally performed as a 2stage procedure. 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. Analysis of the gracilis myocutaneous flap as a workhorse flap for. Gracilis flap with supply from the superficial femoral artery. 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. Urologygracilis flap placement urology coding ask an. Gracilis myocutaneous flap, iscial pressure sore, perineal. The choice of free or pedicled gracilis is usually determined by the degree of cutaneous soft tissue reconstruction required. Urologygracilis flap placement urology coding ask an expert. Refining the outcome of flap breast reconstruction. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional.
The history of flap surgery dates as far back as 600 bc, when sushruta samita described nasal reconstruction using a. A low morbidity alternative to the tug, gap, and pap flaps erez dayan, m. Outcomes after retroflexed gracilis muscle flap for vascular. In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. While the abdominal donor site is often the first choice for autologous breast reconstruction, it may not. This technique is a variation from morasch et al in which they had mobilized the gracilis muscle from the pubic bone and passed through the adductor longus. Outcomes after retroflexed gracilis muscle flap for. With either technique, the gracilis muscle is transferred into the rectus femoris.
Gracilis muscle interposition with primary rectal without. The gracilis muscle flap is another option for the repair of fistulas. This study quantifies the fasciocutaneous vascular. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and high.
The gracilis flap was then inset proximally and distally into the pocket and its nerve coapted to the masseteric nerve endtoend, followed by arterial and venous anastomosis of the flap to their recipient vessels figure 1. However, series only contain small numbers and an optimal management has not yet. A 2stage procedure with a crossface nerve graft followed by gracilis free flap inset is advocated. Gracilis free flap for smile reanimation iowa head and neck. The technique of utilizing a single gracilis functional muscle transfer. A medline research for transverse gracilis flap reveals 46 articles, including all important articles about transverse upper gracilis and transverse musculocutaneous gracilis flap breast reconstruction. Both pedicled and free flaps can be muscular or musculocutaneos the so called composite flaps. A novel perforatorbased flap for reconstruction of post.
The term flap originated in the 16th century from the dutch word flappe, meaning something that hung broad and loose, fastened only by one side. Urinary and fecal diversion is the firststep operation. Flap revision surgery aesthetic plastic surgery, pc. Fistulae between an ileal pouch and the vagina are an uncommon complication of ileal pouchanal anastomosis following proctocolectomy and mucosectomy in patients with familial adenomatous polyposis coli. Original article experience with a modified technique of. Aug 26, 2017 the gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. Gracilis myocutaneous flap in reconstruction of the vulva.
Jan 23, 2018 this is video power point presentation of gracilis muscle flap conplete reading on anatomy harvesting technique and practical diffiuculty of flap harvest and various uses in coverage of the. The linear incision in the medial thigh is made at the inferior border of the adductor longus to expose the gracilis. Modified technique of gracilis flap harvest condyle between the sartorius and semitendinosus muscles. Case report prelaminated gracilis flap with buccal mucosal. In 1990, obrien was the first to report the use of the gracilis free flap for singlestage facial reanimation. The coverage of the scrotal defect site can protect testicles without increasing the temperature. The transverse orientation of the flap allows for a large skin paddle, with some independence from the muscle below. Sequential chimeric medial femoral condyle and anterolateral thigh flow. Gracilis muscle flap for scrotal reconstruction easily covers the scrotal defects with deep pockets. Gracilis flap for perineal closures in minimally invasive abdominoperineal resection.
Pdf lower lip reconstruction using a functioning gracilis. The flap has an adequate length, can be rotated easily into the perineum and brings wellvascularised muscle to irradiated or traumatised tissue. Then do vessel anastomosis, then neurorraphy, then distal lateral insetting. It serves as a mechanical barrier between the urethra or vagina and the rectum. This myocutaneous flap uses the medial circumflex artery and venae comitantes to reliably perfuse a sizable. Case report prelaminated gracilis flap with buccal mucosal graft for salvage of devastated urethra dmitriynikolavsky department of urology, suny upstate medical university, e. Vaginal reconstruction 445 d figure 5 unilateral gracilis myocutaneous flaps a, preoperative view showing a partial vaginal defect. The cutaneous perforators of the gracilis muscle supply both the anterior and posterior inner thigh skin reliably. Free gracilis muscle flap for sarcoma reconstruction. Flap monitoring was assisted with handdoppler ultrasound and the patients stayed in the hospital for 5 to 7 days. Just as breast implant reconstruction is typically done in stages, natural tissue breast reconstruction frequently requires secondary revision surgery to achieve an optimal breast shape.
There are two secondary pedicles to the gracilis muscle, that can be found segmentally and distal to the proximal pedicle. Gracilis transposition is an effective option to cover exposed vessels or salvage prosthetic graft material. Fuchan wei and samir mardini, explains how to achieve excellent results while performing all major conventional and perforator flaps used as both pedicled and free flap procedures. In appropriately selected patients with vascular reconstructions and groin infection, when complete graft removal and extraanatomic bypass is not an acceptable option, gracilis muscle flap coverage is a viable alternative. Lower lip reconstruction using a functioning gracilis. The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. Superficial to deep in oo, then deepsup of muscle flap, then back sup to deep at oo at same spot as before and back through flap then tie off.
A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief. Gracilis flap with supply from the superficial femoral. A quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction iain s. In appropriately selected patients with vascular reconstructions and groin infection, when complete graft removal and extraanatomic bypass is not an acceptable option, gracilis muscle flap coverage is. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to help patients correct their facial paralysis symptoms.
Efficiencies and design tips edward w buchel bsc md facs, kimberly r dalke msc, thomas ej hayakawa md frcsc section of plastic surgery, university of manitoba, winnipeg, manitoba. The gracilis muscle flap is well known to provide the best reconstructive option for major scrotal defects. In this article we describe a novel perforatorbased fasciocutaneous flap for the management of groin contracture and describe the anatomical basis of. This is video power point presentation of gracilis muscle flap conplete reading on anatomy harvesting technique and practical diffiuculty of. Lin, harvard medical school, united states of america. The gracilis muscle free flap is generally performed as a 2stage procedure. Early results with use of gracilis muscle flap coverage of. Mangelnde anschlussmoglichkeiten im empfangerareal. 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. Modern perforator flap imaging with highresolution blood pool mr angiography1 advances in microsurgical techniques have improved autologous reconstructions by providing new donor site options while decreas ing donor site morbidity. The gracilis free flap is a viable option for large extremit.
With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2 nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Gracilis muscle is widely used in reconstructive surgery graciloplasty, either as a pedicled flap or as a free microsurgical flap. Several reports describe the successful use of muscle flaps to close recurrent pouchvaginalfistulae pvf. However, series only contain small numbers and an optimal management has. Background mastectomies are one of the most common surgical procedures in women of the developed world. Once healing is complete following the first stage of flap breast reconstruction, any potential contour problems can be identified and. Retroperitoneal urinoma spontaneously drained in the. Pdf the lips are highly visible structures on the face, providing oral competence and. Functional free muscle flap facial paralysis surgery. The transverse upper gracilis tug flap harvests this skin and fat in a horizontally oriented ellipse along the medial aspect of the thigh, which was initially described by yousif et al in 1992, with the first clinical reports in 1993. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. Better results when used to augment other techniques xii to vii, gracilis free flap, serratus free flap dynamic reanimation neuromuscular transfer used when the extent of nerve or muscle atrophy precludes the use of nerve substitution techniques stage 3 used to augment unsatisfactory reinnervation procedures.
Lokaler weichteilschaden an beiden oberschenkeln medialseitig. A singapore flap was not possible because of extension of the defect onto the medial aspect of the thigh. Then this was laid posterior to the anastomosis and the muscle flap was laid anterior over the suture line and tacked in. Transverse upper gracilis flap for breast reconstruction. Gracilis muscle free flap transplant facial paralysis institute. Lower lip reconstruction using a functioning gracilis muscle. Presented at the fortieth annual meeting of the society for clinical vascular surgery, las vegas, nev, march 1214, 2012. The axis of this flap is then marked oblique and posterior, parallel to langers lines where a pinch test determines the flap width figure 1. Facial muscles may be removed during tumor excision or damaged by trauma. Free muscle flaps for reconstruction of upper limb defects. If there is a relatively small cutaneous defect, then both the functional quadriceps reconstruction and soft tissue reconstruction are accomplished by a single free contralateral gracilis myocutaneous flap. Our study was aimed to describe the vascular anatomy of the gracilis muscle and the related skin, in order to have a better understanding of the skins blood supply, and to help in determining a safer cutaneous paddle during transfer. Indications the gracilis flap muscleonly or musculocutaneous flap is a workhorse for the coverage of small to mediumsized defects, with virtually no donor site morbidity.
Gracilis flap for perineal closures in minimally invasive. It can be harvested with a skin paddle see tug flap. Studying some of these articles, the authors could have avoided the visible scar on the frontal aspect of the thigh as shown in their. The gracilis myocutaneous flap is favoured by many reconstructive. Lower lip reconstruction using a functioning gracilis muscle free flap article pdf available in seminars in plastic surgery 242.
The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. Gracilis muscle interposition for the treatment of recto. Outcomes after retroflexed gracilis muscle flap for vascular infections. With extremely short leashes, they are not used for revascularizing the gracilis as a free flap. Gracilis muscle interposition in conjunction with primary rectal repair but without urethral reconstruction is one of the reconstructive surgery options for moderate 2cm to 3cm rectourethral fistulas.
Various preoperative imaging modalities have been studied to assess the relevant vascular anatomic struc. The history of flap surgery dates as far back as 600 bc, when sushruta samita described nasal reconstruction using a cheek flap. The are both ligated and divided when the muscle is harvested. Our indications to use the functioning gracilis muscle flap in lip reconstruction are as. Other flaps are alt flap and vertical rectus abdominis muscle flap, which may require long transit of pedicle, microsurgical expertise, increased donor site morbidity, and may result in a bulky flap. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients. Vaginal reconstruction washingtonian plastic surgery. Functioning free gracilis transfer to reconstruct elbow. Split pedicle for bilateral free deep inferior epigastric perforator flap. Two venae, one usually slightly larger than the artery. The gracilis musculocutaneous flap as a method of closure. The gracilismyocutaneous flap is useful in reconstruction of. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to.
This pdf is available for free download from a site hosted by medknow publications. In this article, the anatomy of the gracilis muscle, alternative neural sources including the masseteric nerve, and. The technique of utilizing a single gracilis functional. Various surgical techniques that have been used include skin grafting, z plasties single and multiple, fasciocutaneous and myocutaneous flaps. This article outlines the various preoperative imaging modalities for perforator flap imaging, such as doppler ultrasonography us, computed tomography ct, and magnetic resonance mr angiography, with a focus on highspatialresolution blood pool mr angiography and our flapspecific protocols. Recurrent fistula between ileal pouch and vaginasuccessful. Gracilis free flap for smile reanimation iowa head and. Gracilis muscle free flap transplant facial paralysis. Outcomes after retroflexed gracilis muscle flap for vascular infections in the groin. Retroperitoneal urinoma spontaneously drained in the scrotum. Gracilis vessels from the medial femoral circumflex system. Superficial skin markstitch placed on skin over vessels. We describe a technique of harvesting a small unit of gracilis based on its minor pedicle and maintaining the continuity and conserving the major bulk of muscle.364 812 749 970 475 383 911 530 1172 698 3 1602 607 552 1170 1123 89 1403 99 249 623 21 1609 1623 388 797 987 530 548 882 255 284 754 277