The gracilis tendon was disinserted, taking care to preserve the sartorius and semitendinosus insertions. The combination of a fasciocutaneous posterior thigh flap and pedicled gracilis flap was a successful reconstructive option in these three cases involving patients with limited mobility. However, the safe skin paddle limits are not yet understood. 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. Gracilis myocutaneous flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for gynecological malignancies, including vulvar cancer.
Convert, edit, merge, read, print pdf documents and create. The use of singapore flaps for vaginal reconstruction in. The skin island could be harvested to a width of up to 30 cm and a height. Your gracilis is a long, slender muscle that runs down the inside of each thigh. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. Described by mcgraw in 1976, 21 the gracilis flap consists of a transversely orientated crescent of skin and fat at the crease between perineum and thigh and the underlying gracilis. Gracilis myocutaneous flap in reconstruction of the vulva. The combined transverse upper gracilis and profunda artery. Perforators can be marked with a pencil doppler to help design the outline of the flap. In this article, the anatomy of the gracilis muscle, alternative neural sources including the masseteric nerve, and. The body lift perforator flap technique as described in this article. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to. Modified technique of gracilis flap harvest condyle between the sartorius and semitendinosus muscles. The gracilis muscle flap for irreparable, impossible.
Watch surgeons perform procedures in real time with an unparalleled twohour video collection that demonstrates harvest of the fibula flap for use in mandible reconstruction, the jejunum for esophagus reconstruction, and the siea, diep and igap flaps for breast reconstruction functioning muscle transfers for a variety of defects, including the gracilis muscle for facial reanimation and the gracilis musculocutaneous flap. The tugpap flap consisted of the combination of two well. Focus volume 16 may, 2004 table 1 summary of data obtained in patients undergoing single gracilis muscle. Anterolaterally, it is covered by the adductor longus and posterolaterally, at its proximal third, it is related to the adductor magnus. Gracilis muscle free flap transplant facial paralysis. Original article experience with a modified technique of.
Gracilis muscular flap for large urethral defect author. It crosses from the lower end of your pelvis to the top of your tibia, the larger of the two bones in your lower leg. The gracilis flap was used for additional healthy tissue for a larger defect and more severe scarring than noted in the other patients. Turbogracilis myocutaneous flap for perineal reconstruction. We noticed simple operative followups in more than 80% of cases and minor postoperative complications such as suture release 5 cases, partial flap necrosis 3 cases and partial lysis of. Yuichiro yoshioka, shigeaki moriura, hiroshi yuba, atsushi hirano, ryohei hattori subject.
Turbo gracilis myocutaneous flap for perineal reconstruction. A 57yearoldman with rectal cancer underwent abdominoperineal resection including part of the prostate and seminal vesicle. We designed a combined posterior thigh flap with pedicled gracilis to provide robust coverage and. Spontaneity assessment in dually innervated gracilis smile. A classification system for muscle and musculocutaneous flaps, described by mathes and nahai in a 1981 prs publication, to date, the have been no alternative classification for muscle flaps commonly used in clinical practice. The vaginal mucosa was incised to enlarge the passage for the gracilis. It just takes a few clicks, and is available in all the latest.
Gracilis free muscle transfer for restoration of function. A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief. Design, setting, and participants cohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs singlesource innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video timestamping spontaneity assessment method. The gracilis flap is an exciting alternative to abdominal, back, or buttock tissue flaps for reconstruction of a naturallooking and soft, shapely breast. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps.
The transverse myocutaneous gracilis flap was used 32 times. The gracilis muscle is located in the inner aspect of the thigh. Background the ability to achieve a longterm, stricturefree urethral repair is one of the ongoing challenges of reconstructive urologic surgery. Then do vessel anastomosis, then neurorraphy, then distal lateral insetting. The gracilis is routinely transferred with a skin paddle for postoperative flap motoring.
Complications from surgery included one patient who required general anaesthesia to complete the gracilis muscle flap after her spinal anaesthetic dissipated. The tendon was necessary to perform the pullthrough. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. It has the advantage of bringing a wellvascularized tissue for reconstruction. In 17 patients the gracilis was used in the ffmt for restoration of elbow flexion.
Among the many cool features and functions of adobe acrobat, it also enables you to rotate pages of a pdf document. Free pdf to flip book is a 100% free windows software to create digital publication from pdf documents, free pdf to flip book allows convert pdf to flip magazine and catalog, create your own professional online digital magazine, company brochures, online publication, digital newspapers, company catalog. Two venae, one usually slightly larger than the artery. The vascular pedicle is the ascending branch of the medial circumflex femoral artery and vein. The gracilis muscle flap as vascularized healthy tissue gives patients with otherwise irreparable obstetric fistulas another option before urinary diversion as 95% are healed. Analysis of the gracilis myocutaneous flap as a workhorse. Sexual adjustment of patients undergoing gracilis myocutaneous flap vaginal reconstruction in conjunction with pelvic exenteration. The method appears effective even in preirradiated patients with larger perineal wounds resulting after total pelvic exenteration for locally advanced. Superficial skin markstitch placed on skin over vessels. A quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction. Gracilis vessels from the medial femoral circumflex system.
The gracilis flap was then tunneled upwards and passed through the subcutaneous plane to emerge at the introitus. The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. The transverse upper gracilis free flap is a welldescribed option for breast reconstruction. The authors have been performing autologous breast reconstruction utilizing the flap with two types of modifications to increase flap volume. Results we share our experience about two of our patients treated for rectal malignancy with pelvic exenteration who were reconstructed immediately with pedicled gracilis myocutaneous flap. The main disadvantage is unpredictable viability of the skin paddle due to. Comparison of onestage free gracilis muscle flap with two. Methods we describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair. In this paper, we prospectively compared the results of the onestage gracilis flap method with the two stage technique. We report the use of gracilis muscle to repair a large urethral defect. The donor scar is concealed and flap harvest is relatively straightforward in a supine position fig 3. Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures.
Check out our before and after images to see how dr. Because it crosses multiple joints, your gracilis performs multiple actions. Plastic surgeon and reconstructive microsurgeon san. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. The gracilis flap may be harvested as either a muscle or a musculocutaneous flap. In this study, we attempted to address this issue based on our experiences with inferior and posterior skin paddle extension. Gracilis free flap harvesting technique coverage youtube. Gracilis flaps for breast reconstruction plastic surgery key. Abstract gracilis muscle flap is commonly used in reconstructive surgery.
The ventral margin was the greater saphenous vein, and the posterior margin was the midline of the inferior gluteal fold. It is better than fasciocutaneous flap in a place where the infection chances are very high. The most commonly used flap for the treatment of ischial tuberosity pressure sores is a musculocutaneous hamstring flap as described by hurteau et al. The muscle is completely expendable and provides bulk. Reconstruction of perineal defects pubmed central pmc.
A 2stage procedure with a crossface nerve graft followed by gracilis free flap inset is advocated. Technique of harvesting the gracilis for free functioning muscle transplantation article pdf available in techniques in hand and upper extremity surgery 104. Modifications to extend the transverse upper gracilis flap. This pdf is available for free download from a site hosted by medknow publications. How to rotate pages in a pdf document using adobe acrobat. Muscle flaps mathes and nahai classification for muscle. Out of 41 patients with facial palsy refered to hazratefatemeh hospi. While the most commonly used flap for typical it ulcers is the musculocutaneous hamstring flap, for these patients, this is not suitable due to the sacrifice of muscle function. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. Gracilis free flap for smile reanimation iowa head and. The use of a combined profunda femoris perforatorbased. It can be harvested with a skin paddle see tug flap. Pdf sexual adjustment of patients undergoing gracilis.
The technique is a secondary choice for autologous breast. Reconstruction of scrotal and perineal defects in fournier. Flip pdf is your easy way to batch convert ordinary pdf files into stunning booklets with amazing pageflipping animations and sound. Gracilis myocutaneous flap is a timehonored flap of choice for perineal reconstruction. The transverse musculocutaneous gracilis tmg flap has become a common solution for breast reconstruction. The transverse myocutaneous gracilis flap has traditionally been used to reconstruct smaller breasts. The gracilis muscle has a consistent and reliable blood supply and has been well described 1,2.
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