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Tissue coverage for exposed vascular reconstructions (grafts)
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kaitlyn Rountree, Vikram Reddy, Sachinder Singh Hans
The gracilis muscle is a long, slender muscle seated superficially on the inner thigh. It functions as an adductor of the thigh, and assists with flexion of the knee and hip. It receives segmental blood supply from the medial circumflex femoral artery (a branch of the deep femoral artery), usually encountered about 10 cm inferior from its origin at the pubic symphysis, and innervation from the obturator nerve. The gracilis muscle flap has long been a work horse of reconstructive surgery in both pedicle and free flap form. Its proximity to the groin makes it a valuable option for native tissue coverage in vascular patients with complicated groin wounds with little residual morbidity. Likewise, its blood supply does not rely on the SFA, which is commonly occluded or compromised in vascular patients with arterial occlusive disease.
Advanced autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The gracilis muscle lies medially beneath the fascia lata of the thigh. It arises from the ischiopubic ramus and inserts as the middle component of the pes anserinus on the medial tibial tuberosity. The muscle belly of the gracilis lies posterior to the adductor longus and sartorius muscles and anterior to the hamstrings (Figure 23.6.1).
The Dynamic Gracilis Procedure
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
C. G. M. I. Baeten, J. Konsten
The question now is, is it possible to change the intrinsic characteristics of the gracilis muscle in such a way that the muscle can act as a tonic muscle for a long period, and is it possible to sustain this contraction independent of will? Previously, in the 1970s, Salmon and Sréter4 proved that it is possible to change muscle fibers by electrical stimulation. Since that time this possibility has been investigated for several muscles and for many applications. Based on this principle it was possible, for instance, to develop the cardiomyoplasty by Carpentier and Chasques.9 This application for the transposed gracilis muscle was first described by Baeten et al.10 Several publications followed which described electrical stimulation applied with an implanted electrical stimulator.5–8
Impact of patients’ gender on microvascular lower extremity reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Nicholas Moellhoff, P. Niclas Broer, Paul I. Heidekrueger, Milomir Ninkovic, Denis Ehrl
Patients’ medical records and hospital files were screened retrospectively. Data analysis included demographics, patient characteristics, perioperative details, postoperative complications, and free flap outcome. Patients’ preoperative physiological status was assessed according to the American Society of Anesthesiologists (ASA) Classification of Physical Status [14]. Surgical complications were divided into major and minor complications. Major complications were defined as total flap loss, partial flap loss of more than 10%, as well as revision surgery due to vascular compromise (arterial or venous thrombosis) or hematoma. Minor complications were defined as partial flap loss of less than 10%, wound dehiscence, skin graft failure and wound infection. Patients were followed up for three months. A separate analysis was performed for anterolateral thigh (ALT) and gracilis muscle flaps, the most commonly used flap types for defect reconstruction in the study population. Complications were also evaluated with regard to the type of anastomosis utilized (end-to-end vs. end-to-side).
Isolating the Superficial Peroneal Nerve Motor Branch to the Peroneus Longus Muscle with Concentric Stimulation during Diagnostic Motor Nerve Biopsy
Published in The Neurodiagnostic Journal, 2022
Ashley Rosenberg, Rachel Pruitt, Sami Saba, Justin W. Silverstein, Randy S. D’Amico
Motor nerve biopsy is a frequent final diagnostic tool to distinguish motor neuropathy from motor neuron disease and may be performed with associated muscle biopsy to diagnose myopathy in patients with focal or diffuse motor weakness. Accurate diagnosis is critical as treatment with immunoglobulin can be effective in select motor neuropathies (Latov et al. 1988; Pestronk et al. 1988). Biopsy of the gracilis muscle and obturator nerve, and the pronator teres muscle and the motor branch of the median nerve supplying it, have been described for diagnosis in suspected lower or upper extremity disease processes, respectively (Berman et al. 1985; Corbo et al. 1997; Dy et al. 2012; Kinoshita et al. 2014). Recently, a technique to biopsy the motor branch to the peroneus longus muscle was described as adequate and sufficient to enable diagnosis in patients with suspected motor neuropathy (D’Amico and Winfree 2017). We describe our techniques for intraoperative neuromonitoring for preservation of motor function during this approach which, to-date have not been described.
Reconstruction of large perineal defects after advanced malignant tumour resection: a simple gluteal thigh flap modification
Published in Journal of Plastic Surgery and Hand Surgery, 2020
The gracilis muscle flap method involves the muscle being elevated from the medial thigh along with the overlying skin and transferred to the perineal region. This reconstruction method is advantageous because of its technical ease. The donor site morbidity is minimum and the bilateral flap can be raised easily to fill the large defect. However, since the blood supply from the muscle to the overlying tissues is unstable, the overlying skin may become necrotic. The rectus abdominis muscle flap method is supposedly the most commonly used method for the pelvic defect reconstruction. It requires transfer of the muscle and overlying fat and skin to the perineal region, consequently providing sufficient volume of tissue to fill the pelvic dead space. However, in our view, this may sometimes be unsuitable for patients with colostomy, urostomy, gastrostomy or any other previous abdominal surgery. In addition, this method sometimes causes postoperative abdominal incisional hernia. In the gluteus maximus muscle flap method, the muscle and overlying tissues are transferred medially in a V–Y fashion, or in a rotating fashion, to cover the defect. This method is useful if the defect does not extend to the pelvic region. However, in cases where the tumour involves wide areas of the perineal region, the medial aspect of the gluteus maximus muscle flap is removed along with the tumour. This shortens the available flap, making it difficult for it to reach the pelvic defect.