Tissue coverage for exposed vascular reconstructions (grafts)
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
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.
Gracilis flap
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The gracilis muscle is a flat and thin adductor muscle of the thigh. It originates from the ramus of the pubic bone and inserts at the medial tibial tuberosity below the knee. The gracilis muscle is a type II muscle according to the classification of Mathes and Nahai with its dominant vascular supply arising from the adductor artery and vein which branch off of the profunda femoris artery and vein. The vascular pedicle commonly has two comitans veins and enters the gracilis muscle 8–10 cm distal to the pubic tubercle. Minor vascular pedicles arise from the superficial femoral artery (distal) and the medial circumflex artery (proximal). The motor nerve supply comes through the anterior branch of the obturator nerve and enters the muscle approximately 2 cm proximal to the vascular pedicle.
Perianal Crohn’s Disease
Laurence R. Sands, Dana R. Sands in Ambulatory Colorectal Surgery, 2008
Gracilis muscle transposition is a major procedure used for the repair of perineal fistulas in patients with severe symptoms who have failed simpler procedures, and is especially helpful in the treatment of persistent rectovaginal and rectourethral fistulas. The gracilis muscle at the medial aspect of the thigh is detached from its attachments near the knee, and dissected free through three small thigh incisions (Fig. 10). Care should be taken to protect the neurovascular bundle supplying the muscle near its origin. The plain between the rectum and the vagina is then dissected to divide the fistula tract, and the rectal opening is repaired. The gracilis muscle is rotated and sutured to interpose between the rectum and the vagina. The success rate with the use of this procedure for Crohn’s rectal vagina fistulas is approximately 70% (53).
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.
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.
The thoracoacromial axis in salvage head and neck reconstructive surgery, a case series
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Matthew J. Davies, Rhys van der Rijt, Roger Haddad, James Southwell-Keely
Fasciocutaneous flaps were used in five out of the six cases with one patient receiving a free gracilis muscle flap. In two out of the six cases, the clavicular branch of the thoracoacromial axis was used for arterial microvascular anastomosis. The microsurgical suture material used in all cases was 8.0 nylon which was employed in an end-to-end arterial anastomosis. All venous anastomoses were performed with the accompanying venae comitantes. Venous couplers were used for the venous microvascular anastomoses and their sizes ranged from 2.0 to 3.5 mm.
Related Knowledge Centers
- Femur
- Pubic Arch
- Pubic Symphysis
- Sartorius Muscle
- Semitendinosus Muscle
- Thigh
- Tibia
- Aponeurosis
- Medial Condyle of Femur
- Medial Condyle of Tibia